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7 , I� �� �'?�� - �/�li <br /> Date1���+- � P�o�,�w�-.5 P�, �. � <br /> � <br /> AppP,cation For oioo.000�-� � ',� <br /> i <br /> PUBLIG WORKS PERMIT PueTalelFeeFee S , <br /> � <br /> LesaAoO�.fae PaIE � 'I <br /> Balence�uB S ��'/ I <br /> Print or Type Only <br /> Uau► �� P�}��n I(�1 a I-Fv��- ��xe,E� QB�U 1 as8-�a99 � � <br /> Owner Mailing Atldress City Zip Phune I <br /> VP�m-� Ri L� /�sa I N ia h�eu 99 Lunh , 9Ro3 '7 7�13- !ss' � <br /> Applicant MailingAddress-� City Zip Phone <br /> i <br /> � , �� / C'1(,, i <br /> Describe Pwposed Work �K3f�Qe� `-J I U r��� _ i <br /> � <br /> W <br /> Projecl Address(il known) � � <br /> Attach�ow (4)copies of plans for proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Cen�erline of streel /A <br /> O Outline and dimensions ol all exis�ing and • Inditate Norih V� <br /> proposed structuies on the lot • Sho'.v any proposed grading changes <br /> Y Exis�ir.g and proposed utilities • Show measuremenls � <br /> or <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT C/�NDITIONS O <br /> 7. A!I calls Ier inspsction shall be made 24 hrs.in advance- phone 259-881 5. � <br /> 2. NI work shall be performed in accordance with this permit and curtent City ol Everett Design and Construction <br /> Stai:da«Is and Specilication;;. <br /> 3. i.all Locntion Undergrountl Servica 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> N � <br /> O � <br /> a <br /> � ACKNrWLEDGEIAENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less �he Cily r,f Everett Irom any and all claims lor Aamages. costs, <br /> ezpenses, or causes of action ihat may a�ise because of installation <br /> � ��r� �, ��� and maintenance ol the improvement oi olher righFol-way use hereto <br /> L " " """�'� � applied lor and further ag�ees lo remom same upm� notice from the <br /> Approved for ns�ruction Date Gity and to replace public property damnged thereby. <br /> � ��� ��-.� -�� �,yyZ `�l,c� ��"l� <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Apnlicant Date <br /> evc�ett PUBLIC WORI(S DEPART�dENT WORK AUTNORIZED BY THIS PERMIT MUST BE STAR7EG WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 8E DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANV.STOPPAGE OF WORK ON iHIS <br /> PROJECT OVER 90 DAVS DURATION. <br /> i <br />