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Date /� /� Pu01i[WorkD Permil s t/ �••��� <br /> eiap.oeot.. <br /> Application For <br /> PUBLIC WORICS PER�1111�' P�blicWo�kaFea $� <br /> Totel Fea <br /> _ _ Less FpO�Fee P91E � <br /> BB18nca Oue s <br /> Print or Type Only <br /> iYli�'o�v/c' �iG'c�' /la/l �'s���Pcii /�6/�.= c v�.ec i'7- <br /> O ner Meiling Address City Zip Phone <br /> �v9f%- �s a_�ai�. <br /> Applicanl Mailing Address City Zip Phone <br /> �J��/ /�cr.E'�Yi`�J'r^ �3�:3- 5/97 <br /> Describe Proposed Work . <br /> /vCf�/�' �' G -�/�'cF'� <c�` <br /> ��.,> .�� f,� �� -- o� � W <br /> Pro�ect Address(if known) �// �c���ec��_ �_' ~ <br /> Attach four(4)copies of p�ans for proposed work- Draw to scale and note the following as applicable: � •� <br /> • Property Lines • Centerline of slreet � <br /> • Outline and dimensions of ail oxisting a.id • Indicale North <br /> proposed struclures cn lhe lot • Show any proposed grading changes <br /> � Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All ca�is for inspection shall be made 24 hrs in advance- phone 259•881 S. � <br /> 2. All work shail be performed in accordance with ihis permit and current Ciry of Everett Design and Conslruction <br /> Standerds nnd Specifications. <br /> 3. Cali Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ` �L�521' �i 6�Nc`—�'J�-�.�J�'�— O <br /> y .S/v"n> ��-`o /7��'�` "( <br /> �. ��2 ,���,��v� �'��s�. � <br /> N��i i ����i.��� <br /> � �cc/f�•Jlri9-� �'- O <br /> r.P�rr� �c����iiJ� c��=l��,�i���� <br /> a <br /> 7 ��,o.E o.� G- �' u/���'- <br /> � �. �T.L�.e /!?!'i� .G��' f�/�-_7 i .t� <br /> /1/p 1�. ^ oZ <br /> � � pc p ACKNOWLEDGEMENT OP CONDITIONS <br /> �� �/ <br /> Tho undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett Ircm any and all r,laims (or damages, costs, <br /> ezpenses, or causes of action that may arise because of installation <br /> , %�/_� and maintenance of the improvement or other riphhol-way use hereto <br /> applied tor and further agrees to remove same upon notice from the <br /> Appro� for Coi structio � Date CiIY and lo replace public property damaged thereby. <br /> �/�-�/�'��---- �,.r-i-�Y � �� /� <br /> Dale � � .LcK�/'�sP 7`/ZF/IfU.°ZFr <br /> FINAL NSPECTION Date <br /> Approved as Constructed S' n t e of Ap�cant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTIY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br /> � <br /> I <br />