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� �s— 77 <br /> Date PuGlitWorksPermi a <br /> Applicatlon For eie9.oeo�.. �S������ y <br /> PUBLlC 1A4�RKS PERMIT PubTo�FeeFee a _ <br /> �ess noat Feu ra�a S — <br /> Balanca0ue $ ������ <br /> Print or Tye=. Only 6 <br /> � ss� <br /> �,�,�� �I�N �;,�- �� �iv �'�z��1 5�a.2 3 y�.�= yil� � <br /> �ne� T Maii ng Address Cit—� Zip Phone ~ <br /> � j �;3- �/bj ,��,, <br /> %"� .-o—o � ✓j,Q�Q � qt.�':., �� ���"�/T �' <br /> �7�v�� �.¢-� <br /> !lpplicant Mailing Address �Cit� Zip Phone <br /> Describe Proposed Work _ <br /> '�¢J J�FiE' __ y � <br /> H �— � <br /> � - - W � <br /> Prolect A��1•ess(if known) �z27— �Oh�BLI�'V .�VE- __ � � � <br /> Attacn four(4�copies of plana tor proposed work• Draw to scale and note ihe lollowing as applicahle: i� Z <br /> i Proper�y Lines • Cen�erline of stree� ♦� � � <br /> • Outline and dimer.sions of all existing and • Indicate Norih v, t�� H <br /> proposed structures on ihe lot • Show any proposed grading changes � � <br /> • Existing and proposed utilities • Show measurements /� � <br /> W o <br /> DO NOT WRITE 3ELOW THIS LINE O � N <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 2a hrs. in advan�e- phone 259•SRi 5. � <br /> 2. AI1 work shall bE performed in accordance with lhis permit and civrent CiP/of Everetl Design and Construction � <br /> Standards and Specifications. N <br /> 3. Call Location Underground ;,ervice�48 hrs�. before you dig.TOLL FHEE M,,MBER 1-800-424•5555. � <br /> O � <br /> � �y <br /> N x <br /> � <br /> � � <br /> � <br /> ACKNOWLED3EMENT OF CONDITIONS <br /> ��,�6 — — The undersigneC owneUapplicant hereby aprees to hoid and save harm- <br /> lese ihe City of c:verett irom any and all claims tor damages, cosis, <br /> � ^ er.penses, or causas ol actior. tha� maV arise because ot installation <br /> � ,-, � � and maintenance ot Ihe improv�:roent or other right-of-way use here�o <br /> ~,�' �j�+'�r��`?� .J �,�� c�i'—>� �pplied for and f�:rther agrees ��.o ramove same upon nctir.e Irom the <br /> �___�____ <br /> Approved for ConsErBct�on �'i�� I C��y and to:eplace public Property damac�ed ihereby, <br /> , E'✓GRETT /3c/ILLIE�2S /�I C , <br /> r� �" � � <br /> _--� ��--" -�"-'�' I J <br /> ��,- � , . � �..� .� <br /> �FlNAL INSPECTIQN ��1e i � � Date <br /> Approved as C onstruc�ecl Sign ture ol Applicant <br /> PUBLIC WORKS DEFARTMENT I WORK AUTH�RI2ED B'i �HIS F'.'_RMIT MUST BE STARTED WITHIN <br /> evcrett 18� DAYS OF DATE PEAMIT IS ISSUED AN� THEREAFTER IS TO <br /> � 3200 Cedar Streat BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,4YA 9d2Gt CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8875 PROJECT OVER 90 DAYS DURATION. <br /> � � <br />