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Date� Public WoiEs Porml�> 8 0- :�%— <br /> Application For oiao.oeo�.>�9� -� _ <br /> PUBLIC WORKS PERM �T �°°���,v�,��Faa — — <br /> To�,�Fae s <br /> Lesa AOC�Feo Peid � <br /> Print or Type Only B'�""`ao"a 5 p°O _ <br /> �3��9' <br /> _�B�e �4i,n,�.0✓oLD !?Y� l3o.�c 3o6,d ��e�zL� ff3�3 ��s- �.o�v <br /> Owner Mailing Address City Zip Phone <br /> t��neS (cw..� �o�ST �7-���5�" dl�. ►�C,.��TJ i��3�3 �s�-�at.3 _ � <br /> Applicant Mailing Address City G Zip Phone m <br /> t .. <br /> Describe Proposed Wurk J/�� � P Crd�r,. r �y ��'S/ C�etil�P� _ ^-� '-� <br /> i -� � <br /> .. -� <br /> vi x <br /> v <br /> m <br /> cv <br /> >/� W mo <br /> � � <br /> Pro�ect Address(if known) �!�'"'J � �h�L l.d.T/G� !/F � � m <br /> s �-Zi <br /> �nn��,iour(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � �^ <br /> • Property Lines • Centerline of streel Q z <br /> • Outline and dimensions of all existfng and • Indicate North � D -1 <br /> proposed structores on lhe lot • Show any proposed grading changes ,.r. � <br /> • Existing and proposed ulilities • Show measurements � -i N <br /> < <br /> � <br /> DO NOT WPITE BELOW THIS LINE � � q <br /> PERMII'CONDITIONS = m <br /> m .+ <br /> 1. All call;;for inspection shall be made 24 hrs. in advance• phone 259•881 5. � N <br /> 2. All work shall be performed in accordance with this permit and current Ciry ol Everett Design and Consiruction � <br /> Standaros and Specifications. � m <br /> 3. Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424-5555. � 3 �� <br /> m <br /> A -Z�I r <br /> �, yf:�C�Gd.rl: /S iP_v4'v�,�'EU Tv PL'S.— ff �r.�/c.ein.aNcE O a <br /> L�42ro�,f"f/ �.� Ti�'E C'o��r��vc ri onJ u�' A.�J � <br /> / -i <br /> ..lNT�.!'iin ST•PEET C .SjvNGlC�ev '�'2� ./lca.rJC %hiS f'.�'e.oE.c'T� � n <br /> ( C C f"'�/ J z <br /> �c�✓r.r�.E 9,vo .��•�' �`d I�O✓E2 Sr. .Dn,�_c i „Q� � <br /> � '" <br /> � <br /> %s/E .���iNTdFF•-�/E �'E.c'Fc.�'inaN�E' LGl�•c.an/�/ S%/4[ c �F O o <br /> �/� COST Of ♦ <br /> ,r�QSEd o,v c�.,s;,e�c;;a..i aF T�ic ,�:2 c%oE .+s�'i+ecr s,—,�e�r -�'• <br /> a � <br /> PLCJS .�.0� _ � m <br /> � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> n The undersiyned owner/opplicant hereby agrees to hold and save harm• <br /> /��—' less the Ciry of EvereU (rom any and all claims for damages, costs, <br /> � _. __��� expenses, or causes of action Ihat may arise because ot installation <br /> / � and maintenance of the improvemenl or other right•obway use hereto <br /> applied lor and further agrees to remove sanie upon nolice Iwm the <br /> Ap uved tor nstru � n Date City and lo replace public pr perty damaged thereby. <br /> / ,, <br /> �i� jil / �J/ G <br /> �-�i��'�(�CY C��"_L� 7 - ��J � _ _ \ . <br /> �FINJ�L INSPECTION D•ate •��'�^� ' � ' <br /> Approved as Constructed Si3 e ol Applicant Dale <br /> everelt PUBLIC WORKS DEPARTMENT H' K AUTHORIZED BY THIS PERMIT MUST BE START[D Wll'HIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPOtJ ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />