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Date <br /> �C � I P�nlc:WoeFs Pc�m�i a �% �� <br /> Application Foi BIEg.Dept t_ �7 ��—, C��IIT�_ <br /> PUBLIC WORKS PERMIT PubIICW0ik9Fea <br /> Tolsl Foo � <br /> LessADol Fee PniE g_ <br /> Print or Type Only BnienceDua s :�2n o0 <br /> ��t�,�. /Yi�c ivl���� l1. A`7' / —ln5�n� �Q. G� �vP/P� ��i� �d� 553- 1�5�� <br /> Owner Ma�ng ddress City Zip Pho�ie <br /> � �'_" <br /> Applicent Mailing Address City Zip Phone <br /> I Descrlbe Proposed VJork �o/ l�P �L!lf F� <br /> Project Address(il known) ��e�� —� E.1/f+G.y.t/L� F�v E, � <br /> Attach lour(4)coples of plans for proposed work- Draw to scale and note the lollowing as applicable: � <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 /> • Existlng and proposed utilities • Show measuremants � <br /> DO NO�f IVRITE 6ELOW THIS LINE O <br /> PEfiMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performad in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location linderground Service 48 hrs. betore you dig.TOLL FREE NUM9ER 1-800•424•5555. � <br /> � /Oi`OL+/�.9.�1//CAG ZNFo�n?9TiC�n/ /�j�O�.iVrO �,/ T�� O <br /> 7' <br /> .9G�L,cA•vT /,dO,C.9r�s Ti.�E iJ�,c�E�✓9y [�/,cG rj� <br /> CLwSTVGTL'D .�T As�P7_02 2C ;� G/.�lJOE_ <br /> �s ,�,sE `�.e o,:�,vE�v�y c:•.�z.r/�E ,s ,-v h�CG�,�/ <,�,- � <br /> i� SOc.•T.. o/� 7Nc' .l' O{' �ivl-�an,✓a A✓c� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The widersigncd owner/applicant hereby ag•ees m hold and save harm- <br /> �Ass Ihe City of Everett from any and all claims lo, damages, cosis, <br /> expenses, or causes ol ar.tion t��,.,t may arise because of insfallation <br /> �-- �f�l-�` � �� ,�7 and maintenance of ihe improvemont or other right•ol-way use hereto <br /> Approved for Con5 ructio � Date applied for and further agrees to remove same upon notice Irom the <br /> / Ciry and to replace public pioperty damaged 6iereby. <br /> � � �G_._� � <br /> I�v >—v2�—CFj // <br /> i , �� <br /> FINAL INSPECTION pe�g �`C� - -� � � ' / � ��' <br /> Approved as Constructed ignature of p icant D e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT N�UST BE ST RTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF DATE PERIJ�IT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANl'STOPPAG�OF WOFK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />