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�//q� s � - zv -� `, � <br /> Date � PubliC Work9 Peimi�• �` �—i% <br /> Application For Bltlg.�ept.s Z�fj'�_ <br /> RUBLIC WOfiKS PERMIT Pu�TotalFeaFee a — <br /> Less Pppl Fee Paia $ <br /> Print or Type Only Balanre0ue $ ZL�u� <br /> + ��,�l e Y�'i3� s.�r <br /> %rl� �-�- Allr.� �o i9�y�l C'�.,d�,,,,,�..�/�.�a N b/1� <br /> Owner Mailing Address City Zip Phone <br /> �n�ft2� <br /> Applicant Mailing Address City Zip Phone <br /> I 1 a �n �A <br /> Describe Proposed Work NPf.I�_Si N�d�A 7�pVHi �vi Yp rrD1�A f 0 <br /> Project Address lit knawn) �L.O� G � 1-1A�7 ry0�,.�A Ay� � <br /> Aflach lour(4)copies ot plans for proposed work• Draw to scale and note the following as applicable: � ' <br /> • Property Lines • Cen�erline of sVeet � � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed strucWres ort the lot • Show any proposed giading rh�r.gcs <br /> • Existing and proposerl i�tilities • Show measuremen!s � <br /> DO NOT WRITE BELOW THIS LINE —� <br /> PERMITCONDITIONS O �. <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � , <br /> 2.All work shall be pedormed in accordance with ihis permit and currant City of Everetl Design a�id Construction <br /> Standards and Specification;. i <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBEH 1-800•424•5555. � <br /> �1� M A X 1 M V NI D �i v�t-.1la�' I,J i 7Tf-1 or- Zo � i N "F2c.^NT � j <br /> Y��u Sc-�r��� � , � •I <br /> � <br /> 5� D��VC W A4' Si-I ALL �3E PnV�-ll r izCr�l P2-ot�.IZT;' L..i vC � i <br /> lo �Dc,� C�r= P�V�.D t"'_c����. � � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> The und=rsigned owner/applicant hereby agre=s to hold antl save harm� <br /> less Ihe City of Everett Irom any and all claims for damages. cosis. <br /> expenses, or causes of action Ihat may arise because of inslallation <br /> �� � rn e� �3 �7�9�, and maintenance ol Ihe improvement or other right�ol-way use hereto <br /> applied lor and luriher agrees to remove same upon notice Irom the <br /> Approved for Consiruc ' Date Ci�y and to replace public property damayed ihereby. <br /> .��G��.. /�_ z"'7 —J/ / <br /> FINAL INSPECTION Date __��� ��%�� /�(O �� <br /> Approved as Consiructed Signature of Applicant Date <br /> everett PUBLICWORKSOEPARTMENT WORK AUTHORIZf_D BY THIS PERMIT MUST BE STAATED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEti IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY I�PON ANY STOFPAGE OF WORK ON THiS <br /> PROJECT OVEF 90 DAYS DURATION. <br />