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. o zz � 87- r <br /> Date �^f 2' Pu01ic WorMs Permii• �7� <br /> pn l� 9 - 7 <br /> ApplicationFor � ��"�� � "�v� BIdB-Depl.• <br /> PUBLIC WORKS PERMIT Pu]IicWorksFee <br /> TolalFeo s <br /> Lms FOP�Fee PniC s <br /> Print or Type Only ea�A��o o�e s Z�=° <br /> Sa�R�E � �vnlTu�n �sr�s 2815 W.rn�2inE �r�7�e. frexett qPz.01 339-1a9s <br /> Owner Mailing Atldress City Zip Phone <br /> Gr-a'�e e Cur►��i. S+wu►5 SF►mme. <br /> Applicant ' �ailing Address City Zip Phone <br /> Describe Proposed Work _60� rnrfPS GYI(1 removu.l of dir� �fur bu.ld�v� Si{s qr /�0�'I�C� <br /> Project Address(if known) �n �Q �2r — �OfS 4 5 (p 1 r�AA ¢ � rhaf 7 � <br /> Attach four(4)copies of plans for proposed work• Draw to scaie and note the following as applicab�e: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shell be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be peAormed in accordance with ihis permit and current City of Everett Desi9n and Construction <br /> Standards and Specifications <br /> 3. Cali Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 5� Ct.b,e,C To a'� lkx.t� •�.�.P Ao,o�v✓�o S.�-�c�/ O <br /> 1�AiE0 �/Z3/�7� <br /> �: /�l.?x,�rlu� ��,�,ey f/=%f/� �� � - �� <br /> ( , oCJ�I�� �'��'f�'�J�� /r�''G r �� sT�9sr�/G/� V� <br /> c/= �S� iL , O <br /> a <br /> ACKNOWLEDGEMENT GF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> � expenses, or causes of action ihat may erise because of installation <br /> ..� ��� �� � and maintenance of the improvement or other righhoFway use hereto <br /> applied lor and lurther agrees to remove same upon notice Irom the <br /> Appro ed or Co �tru i Date <br /> � � ; City and to replace public property damaged thereby. <br /> � ����f � <br /> FINAL INSPECTION Date ������� /(�gL_�D " y� <br /> Approved as Constructed Si nature of Appli t� D� <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED B'f THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />