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�- � <br /> r � <br /> Date � �3 �y P�o���wa,ks Pa,m��e � 4 g l — <br /> BIaB.OepLs 84'�/3 c'l30 <br /> Apnlicalion For <br /> F��JBL,IL WO`RKS PERMIT PutbcWoiksFee <br /> TotG Feo � �� p� <br /> Le85 ApP� Fe¢Paid � <br /> Balan<o�ue S '�' p� ' <br /> Print or Type Only G���c,! <br /> / <br /> ��o��,,e� C . t'1'eed� 2z1 `•�c E�euk Mati w,�w E��-. �Jd��` 77(0 " 7S`!� <br /> Owner Mailing Addrass Cit / Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> � 5 �2 <br /> Describe Proposed Work �" <br /> W <br /> Prolect Address(if known) �� �� __`^�c'r c.'� � <br /> Attach four(4)copies M plans for proposed•.vork- Drew to scale and note:he followin9 as applicable: � <br /> • Property Li�,�es • Centerline ot street ♦A <br /> • OuGine and dimensions of all existing and • Indicate North V� <br /> proposed 5�rudure5 on the loi ! Show any proposed arading Changes <br /> • Exisling and proposed utilities • Show measurements � <br /> DO NOT WRITE BE�OW THIS LINE /\ <br /> PERMIT CONDITiONS �� <br /> 1. All calls lor inspection shall be made 24 hrs. in 2dvance- phone 259•881.ri. � <br /> 2. All work shall be performed in accoraance with this permil aad current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Locatlon Underground Service 48 hrs. belore you dig.TGLL rREE NUMBER 1-800•424-5555. � <br /> P'�c3.t� ���—� �1 h�`� inr S(a u�av� O <br /> ♦�A <br /> V♦ <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/aFPlicanl hereby ac�rees to hold and save harm- <br /> less the Ciry of Everet� trom any and all claims for damages, cos�s, <br /> � expenses, or causes of action that may arise hecause ol installation <br /> _� ��L�� /��.- !/�� J_/1_,}y and maintenance ot the imProvemeN or other right-ot-waY use hereto <br /> i� •��Y '""`��` � applied for and further agrees to remove same upon notice irom the <br /> A rov d or uction Date �v�y d.1 replace public property damaged Ihereby. <br /> s I G -l� yy /a� u <br /> FINAL �NSPECTION �a�e . � Da1e <br /> Approved as Cons�ructed Signature t Ap icant <br /> WCRK AUTHORIZE 6r THia �-�A!�11i MUST BE STARTED WITHIN <br /> everett PUBUC W KSD- ARTMENT 780 DAYS UF DAT9 PERf�1i� ��� '''ED AND THEREAFTER IS TO <br /> � 3200 Cedar BE DILIGENTLY PUFSUF� �� �'�..E�:iON.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY TFtE C!TY�� -Y S77PPA3E OF WORK ON THIS <br /> Phnne: 259-887 5 PROJ ECT OV ER 90 DAYS^'.�A�,�:.'�. <br /> � � <br />