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, <br /> Date�U� q9 �J� <br /> � PUEiic Works Permil s � � <br /> Application For eiaa�oea�.:�_/>�,2 �_ <br /> 7��r.� <br /> P'UBLIC WORKS PERMIT P�o��=W��k,F�e <br /> TolalFea � <br /> Less qpP�Fee Paid � <br /> Print or Type Only Baianca0ue 5__)��CJ�L <br /> �-7r�.ne�,,a..�- �; »„�, �1 L.3I�-2n�''`S P �/ (/'� �yy/�� 4 � ���`���7 <br /> Owner –T�"–' Mailiny Address /��rr"—'����'�`^"_� `��D�� <br /> y Z�P - Phone <br /> r <br /> _—.�r� ,„ o <br /> ,lpplicant Mailing AdCress City Zip Phone <br /> Descritu Prcposed Work _�,��i / ���p�p � r,��,0 _ <br /> Projec!Address(if known) __ 7 fO9 – ��.r�L ,�t �2 ` `� <br /> Atlach fou�(4)copies of plans for proposed work- Draw�o scale and note the following as applicable: � <br /> Y Property Lines � <br /> s Centerline of sheet � <br /> O OmiinP and dimenai�r,:,of all existing and • Indicate North <br /> proposed s!ructur�s on the lot o Show any proposed greding chanoes <br /> a Exis�ing and proposed utilities • Show measuraments <br /> DO N07 WRITE BELOW THIS LINE � <br /> PER6llT CONUITIONS � <br /> 7.All calls for!rspection shall be made 24 hrs,in advance•phone 259•8810. <br /> 2.All work sl�ali be peAormed in�ccordance with this permit and current City of Everett Design and Construcr'�n � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service qg hrs.bafore you dig.TOLL FREE NUh7BER 1•800•474•�S.riS. <br /> � ��COCZ/_^��U I�-t' C�lh�tCi �..L�•✓ (�C�-eeitv+S/ � � <br /> /� <br /> -,�i1L�«.:�v �u�. a�Ofy�cue�e�-,� 3-�u�89 <br /> `� [C���CG�y �"h�u-c.¢���07i�t .�-'��'� 2 �Z�PLrtC�nve:J � i � <br /> //� �y� n �J �///� � � <br /> �/,C�IL-�CC JL�YXi"��i S�.�a�//� �.L� -Ga�✓ rZYW� �/p�.) � <br /> y!� / (.�cs� 07,�!'n..�, <br /> 4 , � � <br /> Q.��iC7:'7t.� �� 2dd <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> — The undersigned owner/applicant hereby agrees te hold and save harrr- <br /> less the City of EvereU trom any and all claims for damages, costs. <br /> � ezpenses, or causes ot aclion that may arise 6ecaus�� of inslailation <br /> `- � �<����� �> �� and maintenance of the improvenenl or o�her right-o!-w.�y use hereto <br /> Approve r ConstrUction Date applied for and furiher agrees to remove same upon notice from the <br /> � / City and to replacq public property damaged thereby. <br /> r�/ � � � <br /> l-� . f E,���-� � D./���Z <br /> FI AL INSPECTION a1e � <br /> Approved as Constructed ip�� f qp lican Date <br /> everett PUBL'CWORKSDEPARTAIENT �'��RK AUTHORIZED BY HIS PERM`� MUST BE STARIED WITHIN <br /> � 320CCedarStreet 780 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evera:t,WA98201 8E L�ILIGENTLY PURSUED TO COMPLETION. THIS PERM1IIT 61AY �E <br /> Phone:259•8810 CANCELLED BY THE CITI'UPON ANY STOPPAGE OF WORf<Otd i�ii� <br /> PROJECT OVER 90 DAYS DURATION. <br />