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Date � �n^ ��J�(/ <br /> � Pu�lic lvorks Germil� "� � "' <br /> Application For emy.oeo��+_ <br /> PUBLIC WORKS PERMIT ouOTolalVFeeFee $ aU �,= <br /> Less Apo�Fee Paie S_ V <br /> Print or Type Oniy BalanceD�o 5 aG• u0 <br /> ��c�.:a e Ka k fo�- f�23 - N. i79 � /�(. Sc��, Gla -9P/3j J�y' 2 - ?76'.�/ <br /> Owner Mailing Adi ess City Zip Phone <br /> 'C�t S4a,.L -El.¢ S 4 ....,� <br /> Applicant Mailing Address C:�y Zip Phone <br /> Describe Proposed Work ��� C�J� ���� �'� Q�✓��� <br /> P:oicct Address(if known} 2 3 F���`'t�� ei � �+J l , � <br /> � <br /> Altach four(4) copies ol plans for proposed Nork- Draw to scale and no�e the lollowing as applicable: � <br /> • Property Lines • Centerline of street f A <br /> • Oulline 3nd dimensions of all existing �and • Indicate North V� <br /> proposed sUucturee on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE I � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•$81 5. � <br /> 2. All work shall be performed in accordance with ihis permit and current Ciry of Everett Design and ConsVuction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 43 hrs. before you dig.TOLL FREE NUMBER 1-SOO•424-5555. � <br /> � C.�IYEr� O�PL '512� 'iNnl� w.�.� �TISY�n� SL W(•a`f_f,� Si[tP �. 1' <br /> ProPt1 n 0 <br /> �r'l� . <br /> ',. �P�.... P �Pr 5kc�.1\ �ae eo.�c, u�,17 �r.. �cr �� �ec�c�r�.[ <br /> �+. �jro-.�c s�nn\1 �o.c C'..+-.i��:cN�.Y b� S•�-f'c+ � 5kt"_ ��...� ��w �..� �w <br /> C.XLS '� 1.n ` C...�.•t'�i-7 �a:`�h PO-'��tPr�� �l WP`:-ILr'I� G i— _I <br /> PN�rGS �.����IviS�rt�� �lar. � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> � less the City ot Everett Irom any and all claims for damages, costs, <br /> expenses, or causes ot action that may arise because of installation <br /> �r s ����-3 and maintenance of ihe improvement or olher right-ol-way use hereto <br /> applied for an turther aprees to remove same upon notice irom the <br /> rov or C iruc ion Date City and to repla e public property damaged thereby. � <br /> � � _._I <br /> ; �� ���` l ti S'�.J�'�Lj� . �'� <br /> FINAL WSPECTION Date \�• ` i � QS• %C, Jn 3 <br /> Approved as Cons�ruded Signatu� Date <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS P RMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFfi IS 70 <br /> Everett, WA 98201 BE DILIGE�TLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCEL�ED[3Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> _! <br />