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� J <br /> fj �IU ' 03 PubllcWorkiPermits "� /�� <br /> Application For eiae�o�a�.,_ <br /> PUCiLIC WORKS PERMIT P°°��°W°,k5fe0 <br /> Total Fea 5 ^� ' � I <br /> Less ApP�Fee PaiC $ ^C� �� <br /> Print or Type Only Balanca Due s S/. // <br /> � ���� �oi�v45 ,(�z;�.c' %C!�x �iGY r,l�nn.�� %P5a 7 753-r%3i <br /> Owner Mailing Address City Zip Phone <br /> ?` /� / �� <br /> �.,�r/!'ii -S.l'ur�E' L��,r'!' G�/.�x�/G� C./',i/��°r'i1 %�.,�07 '753873i <br /> Applicant' Mailing Address City "Lip Phone <br /> 9 e <br /> Describe Prop/os�ed Work �0.25��G�i�d,= C� ���/rL � �/ii� _l �"' ���,�,,pE'-" ,-i5 t�hi,� <br /> /�i7nl� /S�l/!'G' S�� ��/',�' <br /> 0 <br /> � <br /> Project Address(if known) �� St-�� ��G��v �� �� �"���- �� � <br /> � <br /> Attach(our(4) copies of plans for proposed work- Draw to scale and note the wing applicable: �� <br /> • Property Lines • Centerlin f street ♦A <br /> • Outline and dimensions of all existing and • Indicate orth V� <br /> proposed structures on the lot • Show ' proposed grading changes <br /> • Existing and proposed utilities Show� easurements �p <br /> iie� <br /> � �O NO RITE BELOW THI INE � <br /> � . <br /> �, PERMIT CONDITIONS <br /> `� � 7. All calls for inspection shall be mad 4 hrs. in dvance- pho 259-881 5. � <br /> `�' 2. All work shall be performed in accord with is permit a currenl City of Everett Design and Construction <br /> � � Standards and Specifications. <br /> � 3. Call Location Underground Service 48 hrs. be ou dig. LL FREE NUMBER 1•800•424-555.ri. � <br /> � I + /) <br /> �� . f'ro .-. �-a�e �a�,.�Ysc �-� ...� �� � e n��i-o..�.� �� �?�b�i` <br /> � 1/vo�c� 1v. 5�,�ec.VWc- Pt',o`- R� �s�,,,r_.....-.z 4 �' � <br /> ` \�^ <br /> Occ.�art.+cy CNr-t�l-�tsv,-�, . <br /> 2 � �-- <br /> �l <br /> W S /�� �n/S' �P�� !o -a��J' - N v�: i ff�J' V♦ <br /> 1q �� ��'/Yl1T �j`iJ0 f,i�f�PsvL�7 /��9n1S /S �oiJT/i✓Gci+7T o�J O <br /> �� //� �St}��//�7f�7T�J/J ��7��% %/%'E�'c [L�vcc.f' i✓J i G�ir"t_f'i <br /> � �9 .�FCoc.il iz_c-w �n���uo.ey !�.✓� f,+�,r�s�r�✓� ���•J !i. <br /> �'i?�ii�C .Si?r/i�GcS CCiJ�ci�'f� s�—.<'✓!c�`- C�P �n.'fJ /Ti,'.E'���� <br /> � �'� �U'oC//9���fh-`� .�E'L"�iT /s' /17GlGc �l�v/�O iF' � <br /> � ��T ACKNOWLEDGEMENTOFCONCITIONS <br /> `�Jv.Jp�Py' <iiUE /�JJZdPT��r �he undersigned owner/applicant hereby agrees to hold and save harm <br /> less ihe City of Ecarett trom any and all claims for damages, costs, <br /> � expen,es, or causes oF action that may arise because ol installalion <br /> �•„� � and maint ance of the improvemeN or other right-of-way use hereto <br /> Approv�tl f ction ^ Date applied f r nd furiher agrees to remove same upon notice from the <br /> City and o eplace public property damaged thereby. <br /> �'l3'l�`� y � �d ����J <br /> FINA TION Date - <br /> Approved as Consiructed Sign Wr of Appl' nt Date <br /> Pverett ?UBLIC WORKS DEPARTMENT WO K UT��IORIZ D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 A S OF DA PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,VJA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Phone: 259-8815 CANCELL[D BY THE CITY UPON ANY STOPPAGE OF'NORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />