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� .,a <br /> � <br /> Date ��y"d� �r � <br /> Pu�lic WorMs Permit r <br /> Application For eiay.oeo�.• <br /> PUBLIC WORF�S PERMIT PublicWarFSFea <br /> TotalFeo � <br /> Less Appl.FEe PaIC $ <br /> Print or Type Only ����� _7��5 ea�a��a o�� S�-��- /2 <br /> �(� �E r��C ��w-�et� <br /> f�(�v-1n.,0 +� g �-$SOC' to`�� ��OOU �a�Cr Ci'R{ ��1�� Seu f`�-(' p�� .I <br /> Owner Mailing Address �i�— 10�"ZS �67-S7g.7 <br /> �^ Z�P Phone <br /> Applicant Mailing qddress City Zip Phone <br /> Describe Froposed Work 1nc�eQ.se �0.0 etQ '�C��-k��nC� o�rce� p-v` �eg'* g��P O�S� <br /> ti�w I�.�� T h� a�lx ��A ' <br /> Project Address(if known) [ � �� �(�er-e(i- /NQ. �� a � <br /> Attach four(4) copies of plans for proposed work• Draw to scale and note the tollowing as applicablc: � <br /> • Property�_ines • Centerline of street � <br /> • Outline und dimensions ot all existing and • Indicate North y <br /> proposed structures on the lot • 3how any proposed gred�ng changes <br /> • Existir�g and proposed utilities • Show measurements � <br /> �� <br /> DO NOT WRITE BELOW THIS LINE <br /> FERMIT CONDITIONS o <br /> L All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Speci(ications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-$00-424-�5555. � <br /> i7f��.�'G!/61� 41//T�1 ,PF'GD/aDS T�J L•ETfC,e, FiE=U/✓I O <br /> �.�.4.f'G/�A�/SEi�/ /�/fs .t/�� G/b'BF_i✓� ST T/n/G- <br /> t y � Tl,�•G T <br /> �X lsT/ill�- G�T_Fic/?'j��h� Sf/ST�i�I Lt/d-S' l�c�'SiC.-H/E-a h <br /> �vd rysr,�rc�E"v ro ,c(CC'OMOdeT�- ;c�v,�a`-- P�� <br /> F�o/n %H/S EkT,�A P,<(�ii/c�'lr. LC"Ti�'2_ T�.a��j� �� <br /> `�-?�- Bsf <br /> . � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applEcant hereby agrees to hold and save harm- <br /> less the City of Everett from anv and all clairt�s for damages, costs, <br /> expenses, or causes ot action that mey arise bec„use el installation <br /> _ ���, � and maintenance of the impr�vement or other riyht-of-way use hereto <br /> Approved Co s, 1v�Qqtion �e applied for and further agree� to remove same upon notice from the <br /> 1 �' Ciry and to replac= public property damaged ihere6y. <br /> FINAL INSPECTION ` S y q ! �-�(' <br /> Date � �� ��/ <br /> Approved as Constructed Sig ture of Appticant ��ate <br /> everett PUB�IC WORKS OEPARTAIENT W K AUTHORIZEC BY THIS PERMIT MI�ST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED ANC THEREAFTER IS TO <br /> Everett,bNA 9II207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STGPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURP.TION. <br />