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//' `�yJ � } `� —���— <br /> Date�(L�,.�G lJ / � Public Workg Permil a <br /> AppliCationFor ///J G�� ��aq.oep�.e � <br /> PUBLiC 11�ORKS PERMIT // PabllcWorksFca �;�, __ <br /> ��� Totx�Fae g� <br /> Less AOp�Fee Vvd 5 <br /> Balvnce Due S. <br /> Print or Type Only <br /> 9, 7z r <br /> .�.9ee�nr�T r��sr,c_ s- .�• r=- 3 5�.9''�� 9��r� 5�7-�aP�- <br /> Owner Mailinc�Address City Zip Phone <br /> —� �,,,�� < y , ,c-� i�.�a d���-r suA'� ��c��s�� S���o� <br /> Applicant Mailing Addreas Cily Zip Phone <br /> Describe Proposed Work � �/ � ��E=`-�� V+")ALL (]�lCae �i9�.� <br /> /C�r/7 — � <br /> Prolect Address(if known) �� ��— �"`""�, ' "' ��!// ��" ��� —_ � <br /> A�lach lour(4) copies of plans(or proposed work- Draw to scale and note the follo�ving as applioable: � <br /> • Property Lines • Centerline of s;reet ♦� <br /> • Ou�!ine and dimensions ul all existinc�and • Indicale Nerlh V� <br /> proposed siructures on ihe loi • Show any proposed gratliny chan9n,s <br /> • Exi;ting and proposcd utilities • Show meTsurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs. in advance- phone 25S•8815. ^ <br /> 2. All H�ork shall be perlormed in accordance with this permit and curr=nt City of Fverett Design and Construction ♦ <br /> Standards and SpecificaUons. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMSER 1-800•424-5555. � <br /> 1 .i, / , � l /' / '��- ' � <br /> �l `-�,�.- Ct��:�i!�t-�`C'G_ ��(C1�S C(C[ , :,_ /�� . �J' <br /> / <br /> �,w <br /> _I <br /> � <br /> a <br /> ACIWO'JJLEDGEMENT OF CONDITIONS <br /> Thc u�. ders�9ned ownedapplicant herehy agiees to hold and save ha+m- <br /> — less the Ciry of Everett Irom any and all �'aims fer Camages, costs, <br /> --�� expenses, or causes of action Iha� may arise because of installatio,i <br /> i--�'� "�%� ' and maintenance ol Ihe improvement or othar right�ol-way use hereto <br /> /� / - � � ' /�l � applied lor and further agrees lo remove same upon no�ice irom the <br /> l��iproved to�Cons�iucljofi �' . Da�e Ciry and to replace pubf Tttq�perty dama ed thereby. <br /> ! � — � <br /> (� � � ��l8 , �_ � /%_ o� r� � <br /> Y 19�,�-4-: .� - �` ,� � <br /> FINAIINSPECTION � Date �� ' " � ' � / <br /> Approved as Conctructe „ignature ol Applicant Da e <br /> WOP.K AUTHORIZED BY THIS PERtviIT MUST BE STARTEC V/ITHIN <br /> everett PUBI.IC WORKS DEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED A�D THEREAFTER IS TO <br /> � 3200 Cedar Slreet 9[ DIL'GENTLY PURSUED TO COMPLETION. THIS PERMIT MP.V BE <br /> Everett,WA 9820? C;�t;G�LLi]D B'i THE CITY UPCfv ANY STOPPf�GE Of'�IOR!<ON THIS <br /> Phone: 259-8815 f�'70JGC7 OVER FiG DAYS DURATION. <br /> � <br />