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� <br /> i, <br /> _,'� l� �� �-tQ�� v '�:' �c.,� <br /> L� L �L� �'��J ' �% L l � <br /> Date �� ' Pubhu 1Vorks Parmic= <br /> eieo.oeo�.�_ -- <br /> Application For <br /> PU8L1G ViIORKS PERIIISIT PublicWorksfee <br /> Totel Fee 5 <br /> Lasa Appl Fee Paltl �— �� <br /> 5 � / <br /> gaI0nC9 DuB <br /> Print or Type Only <br /> l. I '- 6 CU�C r.� �I tt c7 L U Y C'-�' <br /> wner Mail g Address City Zip Phone <br /> CAS�A 0 C ��� A SoNt�Y �GSToRt9Tt�N ri�� PQ "l3o�13�a7 �v�inwc<� � 1'O�/(o 77�-/-C��37 <br /> ApplicaM Madmg Addr ss City Zip Phone <br /> c� N � �V� tll P to r C�ri +eC ac_ ' � .�om�c�a <br /> Describe Praposed Work � <br /> 7%j�/�3�_fj� I�i�r��l �'o +�la� !a�/�1rr� � h o�/- r�o r'Fi�„ 5 a- <br /> ���� <br /> � .�<5 - W <br /> ProlectAddress(ifknown) �^- ����•-� � �c�„ beftil � <br /> Attach tour(4) copies of plans for proposed work• Draw to scale and note lhe following as applirable: � <br /> • Properry�ines • Centerline of sireet � <br /> � Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> r� DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS I <br /> 1. All calls for inspec�ion shall be made 2a hrs. in advance- phone 259•8815. � <br /> 2. All work shall be performed in accordanc�. with this permit and current Ciry of Everett Desi�n avd Construction <br /> Standards and Specifications � <br /> 3. Call Location Underground Service 48 hrs. beture you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> T;��,�fiG E P6L�. CO.VT�C'O L To G-'�'� � <br /> �' ..�'.!.i� �I >- -i� .,��S�'.�= �:. :>.ci <br /> � � v <br /> GF TyE C�,y" `''� c i'�" i��d'c i�- %'i':='r-` � <br /> f/✓t r:'�•' �?,:' . � <br /> � <br /> l��B�a <br /> ACKNOWLEDGEMENT OF CONCIITIGNS <br /> The undersigned owner/aGPlicent hereby agrees to hold and save harm- <br /> ___—. !ess the City of Everett trom any and all claims for damages, costs, <br /> expenses, or causes ot aclion that may arise because of instal�etion <br /> �i � and maintenance of tha improvement or olher righFof�way use hereto <br /> �"�,���./% � -- y^ / ���/ � applied tor and lurthar agrees to remove same upon notice frnm the <br /> Appr ved for Construction Date City and to replece puL•lic property dam�ged thereby. <br /> ( 1 <br /> _:�✓ �L(��--jo- 3/-d'�' y� l �i_ � �� ��/D ' <br /> I°iNAL'iNSPECTION �a1e i ate <br /> �pproved as Constructed Signature of Applica <br /> N'ORK AUINURIZED THIS PERMIT MUST E'E SSARTE.D WITHIN <br /> everett PUBLIC WORKS DEPAF7MENT �g0 DAYS OF DA7E P RMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street HE DILIuENTLY PURSUED TO COMPLETION. THIS PfRMiT IdAY BE <br /> Everelt,WA 98207 CANC[LLED BY THF CITY UPON ANY STOPPAGE OF N'ORK ON THIS <br /> Phone: 259-88t 5 I Pf;OJECT OVER �0 L'AYS DU�7AllON. <br />