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<iZo..���.�rF // ,' -1 <br /> Date-� �C' � Pubiic\VodsPermit� �-/ u1—�v <br /> eioo.o�ci�+ <br /> Application For <br /> i�UBLIC WQRKS PERMIT PLeTotaFeeFee S - <br /> Lass 4pp1.Feo Pe�d 5 C`v, <br /> Balan<nDue S a' . <br /> Print or Type Only <br /> Dt��o�f ���o�, `�9,� 8 �/� �y��ef� 9Q�� �s�-�G/7 <br /> Own Mailing Address City Zip Phone <br /> z <br /> �' ,�� �/9�2 g �Im �!/e�/c'7�1 9 80�;__c�`�-3�l � � <br /> pw�Q , y-T� !r/4 ,, '� <br /> A icant Mailiny Add�ess City Zip Phone � <br /> m <br /> � � <br /> Describe Proposed Work _ � �~ <br /> � � <br /> —" SEF .971r'Gf/�'.G7 �$'�G`ET f/ — vi s <br /> 0 <br /> m <br /> W = � <br /> m � <br /> -i c <br /> i �'3D �Nv l/Q.f� � � m <br /> Proiecl Address(if known � — <br /> s —Zi <br /> Attach four(4)copies of plans lor proposed work-Draw to scale and note Ihe foilowing as applicnble: S m <br /> • PropeAy Lines • Centerline ol street � p z <br /> c <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed strucW res on the lot � Show any proposed grading changes � _ <br /> • Ezisting and proposed utilities � • Show meacurements /M � N <br /> W -� <br /> DO NOT WRITE BELOW THIS LINE O � 3 <br /> PERMIT CONDITIONS x m <br /> m � <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. N <br /> 2, P.II work shall be performed in accordance with lhis permit and current City oi Everett Desiqn and Construction � o r <br /> Stimdards and Specitications. n m <br /> 3. Call Location Undnrground Service 48 hrs.before you dig.TULL FREE NUMBER 1•800•424•5555. � � "' <br /> � N <br /> z n <br /> L/ 7� O � m <br /> J, .li.P/U�G/.s'f' Cr.�.��6' C.lii T� �E .!�t/sTi9cG�-� n <br /> �7E2 6iT� S7A,✓Diy.e� �`-�'07 -�i <br /> i -� � a <br /> ., ... Z <br /> v♦ � <br /> � <br /> � N <br /> Z <br /> 0 <br /> _ a � <br /> n <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less the City ol fEverett Irom any and all claims tor damages, costs, <br /> eapenses. or cau::es ol action that may ari5e because of instal�ation <br /> ��/� fJ ��OiB� and maintenance ol the improvement or other righFo4way use hereto <br /> e� .�iJ7O")���' aFlP��ed for and further agrees to removn same upon notice Irom Ihe <br /> Approved�r Construction �/ Date Ciry and to replace public property damaged thereby. <br /> ��i(l�� � ���� �" .j� � w ��� <br /> L SPECTION Oale Date <br /> Approved as Constructed Signature ol icant <br /> WORK AUT RIZED BY THIS PERMIT MUST BE SIARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DIIIG[NTLY PURSU[D TO COMPLETICIN. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK UN 7HIS <br /> Phonc: 259�8815 pFOJECT OVER 90 DAYS DURAi-ION. <br />