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� �j 305 <br /> Date �����J �•��:: ���,�,�,P.��, c�8— <br /> ea:a oeo�.• ��. <br /> Application Foi � � <br /> PUBLIC WOaKS PERMIT °°°��°w°��SFee -- <br /> Total�ee 5 <br /> LrssAOGI.Fce Paid 5 <br /> o��,��e o�e S ZC��O <br /> Print or Type Only <br /> �� i9� � ����� �- ��,�'�' r �J3�01 ��4-1�-15R <br /> Owner Mailmg Addre� City Zip Phone <br /> �� - �i Lt � t�sa i ��' �'` ��n3 7 ��� -(5 <br /> Applicanl 1-0ailing Adtlres� Ciry Z�p Phone �5 <br /> Describe Proposetl Work ���� � `{ �L��( �L �� -- <br /> � <br /> _ � Q — � <br /> Project Address'il known) .�..� — — � <br /> Attach lour(4)copie�of pl3ns for proposed work• Draw to scale ard no�e the lollowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show mea;wements Y <br /> Yr <br /> DO NOT WRITE BELOW THIS LIPJE � <br /> PERMIT CONDITIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current Gity of Everett Desiyn and Construction <br /> Standards and Specilicalions. <br /> 3.Call Locaticn Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> �w <br /> �/ <br /> O <br /> a <br /> ACKNOWLEDGEMEM�OF CONDITIONS <br /> ��__ The undersi9ned owner/applicar;hereby agrees tn hoid and savc harrn- <br /> less thc Gty ol Everelt fmm any and 311 claims lor damages, costs. <br /> � / ///777 �9 ezpenses, or causes ol action ihat may arise because of inslallation <br /> L `��L' /�__ y _ `] 26 p� and maintenance ot the impwvement or other right�ol�way use hereto <br /> '������� � � applied lor and Iwther agiees to i^move same upon nolice Irom �he <br /> Approved lor Coiulruction D te City and to replace public property tlama9ed thereby. <br /> .� � ' i � <br /> ' —� �10�`t� ,�'� `i' �� �_�7 `� <br /> FIN PECTION Date � <br /> Approved as Const�ucted gnature ol Applicant Date <br /> everett PUEUC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 6E STARTED WITHIN <br /> 1B0 DAYS OF DATE PERMIT IS ISSIiED AND TIIEREAFTER IS TJ <br /> � 320 .CedarStreet BE DILIG[NTLY PURSUED TO COMPLE?ION. THIS PERMIT MAV BE <br /> Lverel!,WA 98201 CANCELLED BY THE CITY UFON ANY STOP1'AGE OF WORK ON �HIS <br /> Phone 25g�OB10 PROJECT OVER 90 DAYS DUfZAi'ION. <br />