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I <br /> I <br /> I <br /> I <br /> � <br /> i <br /> � <br /> Du ' I���� PubliC WOrF9 PB�m �" � <br /> fi10� Depl.• � ��ss�� <br /> Applica�inn ���r <br /> PUBLIC WORKS PERMIT PueTo�FeeFeo � -- <br /> Less F00� Fee PaN $! ^//�� <br /> 001pnCC�OC �1 /'•-'� <br /> Print or Type Only <br /> �Y�.�,����za�ri��� �t I�1�-� - � ��J�� ��� #r�� i <br /> W�e� MailingAddress Cdy Lp L,J Phone <br /> ��/�-fl�l� � 1�'1 i I� �'.I�PP� ��O!� <br /> Applicant Mailinc�Atldress City 2ip Phone <br /> Describe Proposed Work ��4 � L��� <br /> W <br /> Project Address pf known) � � `� �' � �'" � �I <br /> Atlach tour(4)copies of plans for proposed work- Draw to scale and note Ihe lollowing as apu�icable: � I <br /> • Property Lines • Cenlerline of stree� � �� <br /> • Outline and dimensions of all ezisting and / Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes . <br /> • Existing and proposed utilities • Show measurements � � <br /> DO NOT WRITE BELON�THIS LINE O ' <br /> PERMIT CONDITIONS <br /> 1.All calls for tnspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424•5555. � I <br /> �� �xls-ri1JF, �ivc-"h�PM /�P�aJ ktuST 8c- �Cri�C�ul="t� .l�vo O I� <br /> 1 EP�acCD w IT1+ n�c-�� �u,z�,� F...-�2_ +�cv o �� � l..tv.� <br /> p1E�T1Nc_ ��r1 STI�� S #30S -{- ��C�CF . � <br /> I <br /> �. 4�1� 71a�vc�.�14�1 �h�izorJ U�iA�� Bc- iNSia���� i�c�z O � <br /> �G iTY Si AN�A�IJ t`�./4V �3cr/ flnrr, 1�:.YL �zTta� � <br /> 3 . 3�� o� ,►� G IT' CF L-V--"i'G�TT S(7l'l.�A-2t� M/bL.���.. a � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/applicant hereby agrees to hold and save harm- <br /> less the City ot Everetl Irom any and all claims for damages, costs, <br /> ezpenses, or causes of action Ihat may anse because ol installation <br /> .�-��G v`� /l7 - h ��n� and mainlenance ol Ihe � rovemenl or olher righPohway use hereto <br /> f� �" `f U applied for and furth rees to rem ve same upon notice trom the <br /> Approved fo�CQn�ttiction Date City and to re c fic aged Ihereby. <br /> ..���Cky L��L��- � r� % �.� ���G"' <br /> FINAL INSPECTION Date <br /> Approved as Construcled Si9 alw ol A �ncant Date <br /> WORK AUTH RI2ED BY THIS P If �1UST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE I <br /> Everetl,WA 9820� CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. . <br />