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Date� �� � Pu01iC WorFa Po�mlt• �� �/� _ <br /> Applicatlon For eia9.oao�.. �� �y%�� <br /> PUBLIC VIIORKS PERMIT PuoTolslFeeFee s <br /> Leas ApP�Fee PeiC S <br /> ea�a��ao�a s /UU Cf/eevE <br />� Print or Type Only j�rt i0 oN vE,�n•�T <br />' � 8�-%b, <br />� �o�ar' t Cn.�� �UeSle�ietd 'SllO Re0.0 ma-n� Ar Fye,�.t,t �{8�03 p',n�,p1-h�4963 <br />, Owner MailingAddress City Z�p 1 Je✓'w.u���e�}2_537.3 <br /> i � z <br />, o <br /> -i <br /> �� „� .. <br /> Applicant Mailing Address City 7ip Phone m <br /> i (� ���� e � <br />( Describe Proposed Work C�nS�-ruc+�" SInAiP 761�Y1.l.cu 1'�QS«�MCQ. - -1 i <br /> .. -� <br /> vi x <br />� m <br /> v <br /> c o <br /> i - � m co'� <br /> Prolect Address(if known) <br /> ��2� — EDGEin���,z L� H � m <br /> x -Zi <br />� Attach lour(4) copies of plans fnr proposed work• Draw to scale and note the following as applicable: � m .-. <br />' • Propehy Lines • Centerline of street � A = <br /> • Outline end aimensio�s ol all ex�sting and • Indicate North � _ <br /> proposed structures on ihe Iot • Sho.v any proposed grading changes �-+ �-+ <br /> • Existing end proposed ulilifies • Show measurements M � N <br /> < <br /> W " <br /> DO NOT WRITE BELOW THIS LINE � n <br /> --i m <br /> PERMIT CONDITIONS m .+ <br />' 1. All calls for inspectlon shell be made 24 hrs in advance- phone 259•881 5. y <br /> 2. All work shall be perlormed in accordance with this permit and curre�t City of Everett Design and Construction � � m <br /> Standards and Specificationa 3 N <br />� 3. Call Locetion Underground Service 4B hrs.before you dig.TOLI FREE NUMBER 1-800•424•5555. � m <br /> z c� <br /> --1 r <br /> O m <br /> a <br /> z <br /> I � <br /> S <br /> � a <br />,� z <br /> � � <br /> x <br /> N <br />� O <br /> O <br /> ..�r <br />� a � <br /> m <br />' ACKNOWLEDGEMENT OF CONDITIONS <br /> /� The undersic�ned owner/applicant here�y agrees to hold and save harm- <br /> less the Ciry of Everett irom any and all claims for damages, ccsts, <br /> / expenses, or causes ol aclion that may arise 6ecause of instail2tion <br /> � / » � / �/�` r,/�s and maiMenance ol lhe improvement or other righhol-way use herelo <br /> yl /a—� tr� 7 �J applied lor and lurther agrees to remove same upon notice irom the <br /> - Aporoved'f''` t ction Date Ciry and to rePlace Public ProPertY damaged thereby. <br /> ^'� ����� �7 '� // ���/� <br /> � /�.t�.Y "/V •5�']/�'� <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 pROJECT OVER 90 DAYS DURATION. <br />