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Hn � <br /> � � <br /> y <br /> a H 1�1-Z`�` � t59 �• <br /> 9 �3 V' Date�`'�'9i � ai�or�woik:aeimn. <br /> r� 91 <br /> H .'�'. eiag oco��+ <br /> y H AppliCation For <br /> �` y � PUBLIC WQRK� F�ERMIT Pu01¢N'mksFcu <br /> p � � Total Fee $ <br /> �i} �-1 � <br /> y H Less Ap01.Fee PaiE 5 <br /> �;± y �y Prinl or l'ype Only TO P05TI N G ��L���� oa���«o�� s Z� <br /> OH <br /> �� g Joh� K'�rK IZ.o3l - -lth PI S LK St�ve.v�S 98258 �`t-�8�}8 <br /> ~ Owner MailingAddress City Zip Phone <br /> 9H <br /> `' Hy �,2��`,;,., Corsbruc_t�on 8111 -315t Av� N6 �'la,lys�711e �SZ7o �59-50�3 <br /> �j y H Applica Mailing Address City Zip Phone <br /> O C N <br /> � � L�1 Describe Proposed Work 1V SF� <br /> HOCyi� — <br /> ii�/ I <br /> Project Address(if known) _I SO� �--O�"�'�b��"C� � I <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the lollowing as applicable: o <br /> • Property Lines o Centerline of street ♦A I' <br /> • OuUine and dimensions of all existing and • Indicate North V d <br /> proposed siructures on the lot • dhow any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> . PERMIT CONDITIONS <br /> f�' 1.All calls for inspeclion shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance wilh ihis permit and current City oi Evemtt Desi�n and Construr.tion <br /> 1 S'andards and Specifications. <br /> �' 3.Call Location Underground Service 48 hrs.before you diq.TOLL FREE NUMBER 1-800•424-5555. � <br /> �_i � <br /> ►_i <br /> o_� ���� C� F"' <br /> �-� � ll L�v���=°-�--- �r�s��� �� `�° '�' � � <br /> � �zv�'S �Pf u � <br /> � � `��u���e �,� �r` `� � w � �. <br /> ►_I �° ��v�� �i_ <br /> ►a� �� N ` 0�� �o��-��� <br /> ' ' � . nhI_/ A NOWLEDGEMENT OF CONDITIONS <br /> '� (Of�iT <br /> The undersigned owner/applicant hereby agrees to hold and save haim- <br /> less the City of Everett from any and all claims lo: dama9es, cosls. <br /> ��� ^ T� ezpenses, or causes of action ihat may arise because of installalion <br /> U � _Z�� ( and maintenance of the improvement or other righbof-way use hereto <br /> i a plied lor and tu�r e�' rees to remove same upon notice irom Ihe <br /> Approved for Construclion Date �Pty and to rep Ce pu nic9Property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signatu plican Date <br /> PUBLICWOR�iSDEPARTMENT WOR AUTHORIZFjO THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DA�f PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY f��RSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EveretL WA 98201 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 pROJECT OVER 90 DAYS DURATION. <br /> j�u <br />