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,� p <br /> Date O P�o�, wo,ksr�,m��. _/ �J- /' ( <br /> ApplicationFor eiey.oepi., _ <br /> P�J�LIC WORKS PERMIT Pu�iicWoiksFee S <br /> Total Fee <br /> L¢55 Appl.F¢2 P�i� S <br /> �- <br /> Print or Type Only ea�a�«o�a s ��"' <br /> 002-322- YO-Gbp- //- f?3/ <br /> �DAvzD ccx,c�7rt�z-. a 3J`f/ �vru�y�� �-r��u2.�-7'r r.�Y� q�ol -�Sz-77rs <br /> Owner Mailing Addrese� City Zip Phone <br /> S�/�L � OGJJI�.� <br /> Applicant Mailing Address Ci�y Zip Phone <br /> Describe Proposed Work /�-�L/WU(/�- .S�C����K/ �G �' �Zi7J'h)6 S �,�.-/�� <br /> h5,.17 �e.�P�At�� c�JL7.s< Ll���i�� i-u,2 l'u?--c�u�7 �� <br /> �Jo'�,�/ ��� G <br /> Project Address(il known) �3�� Lv�a,�.� � W <br /> AQach four(4)cOpies of pl�ns for pwposed work- Draw to scale and note the following as applicable: � <br /> i Property Lines ! Centerline of street � <br /> • OuUine and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS I.INE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with ih�s permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location ilnderground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> � � <br /> �� /��� -�—// i �p �o <br /> . Gerr�N�fi�' Q/'�.eG'GUl/ee� 6�l:3 CL.�fG a,y 4"Ci'ULe O <br /> / �r �, <br /> 5���<<�,�,�ti . S�c 2ZT.��'�:� 04/30/90 9:08AM OOOA�1�69 �k11: <br /> / r <br /> ;10�03.�361 //� <br /> D�'T,20 :20,OD V♦ <br /> CH"cCS; 9•�0,00 O <br /> a <br /> ACKNOWLEDGEMENT OF CONDI710NS <br /> The undersioned owner/applicant hereby agrees to hold and save harm- <br /> � less the City of Ever2tt irom any and all claims for damages, costs. <br /> exoenses, or causes of action thal may arise because of insta'lation <br /> �J,/ ' / �/ and maintenance ol ihe improvemer� or other right-of�way use here�o <br /> -n"" ��r "� �l 9� applied'tor and t�lier a�prees t remove same upon notice trom the <br /> Approved for Construction Date <br /> / / City and to repJa�ce publib prope ry darnaged thereby. <br /> ..s�'���-�C��(J--�— r,a '!r- J`�o � i <br /> FINA �INSPECTION Cate _{:�Lf%�� ��� <br /> Approved as Consirucled Signature o�Applicant � Date <br /> everet[ PU3LIC WORKS DEPARTMENT WORK AUTHORIZ.ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 320C���darSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> Eve�ett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT P.4AV BE <br /> Phone:259�8810 CANCELLED BY THE CI IY UPUN ANY STOPPAGt(�F WOHK ON IHIS <br /> PROJECT OVER 90 DAYS DURATION. <br />