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Date� -w��p PUGI¢Works Permn• � � /✓U <br /> AppliCation For oiog Deo�.s_�-� � /4 9 4n _ <br /> I' <br /> PUBLIC WORKS PERMIT ruUtotalFoeFeo g <br /> Lezs Aoo.Fee Pa�f 5_ <br /> ex.,:,.00�.,, $ ��.�0 <br /> Prinf or Type Only — — <br /> ICen �l�P� lDS�G —1 yG 'K Sf _S(A ) Edm�arv�s 1��j4 9,f ��o <br /> Owner Mailing Address City Zip Phone <br /> 1 YI 1 AlPlic�l/�- l9 !UI'tL ��� dre�—�L�� CYV� �O��n Z Sy—Zq o(Lc ___— <br /> Ad <br /> Describe Prcp�,�crl Work l.JU/C6 �C�OC,��,�J/ ,.9,f/Q �'Q�tl,('T.Q//L7' �$f l"i'l'. <br /> Project Address�il known) d � � pEr 1�b:'L J 7- � <br /> � <br /> Attach lour�4) copies ol plans for proposed work� Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centerline ol street /w <br /> • Outline and dimensions ol all existin�and • Indicate IJnrlh Vd <br /> proposed strucWres on Ihe lot • Show acy proposed grading changes <br /> • Existiny and Uroposed utililies • Show measurements u <br /> �i�1 <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All cails for inspection shall be made 24 hrs.in advance-phone 259•88�0. � <br /> 2.FlII work shall be pedormed in accordance with this permit and r.urrent Ci�y of Everett Design and Cons�ruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Scvice 48 hrs.betnre you di,.70LL PRE-NUMBER 1-800•424•SW55. � <br /> y ��c�.�,QY i,f .voT To d,� ov�;2 3�y�by � <br /> .S �oG�,t'Py Ta � CONST•elicT�Q P��' CiTy S;A.�oyeo �.3�f' � <br /> 6 S�ot�� o,d /�r/EST P,eo,�s.zr� ,;✓.vE To j'� in,.✓i�wm oF a=/, V♦ <br /> �' �i!� ,t?v,e.u�vG �F 7�c't'L� LZE'9�vtiG'ES Gu�Ti,��vT Till� fJ.�,v,edv/,'C � <br /> p{ T.�d' Fi.e� v.��T. A�✓D 7/i ,�'vc.€r sou.vv ;�U�tv.-�n�✓ CoN.-�-oL �'D.�'J. � <br /> �, J�'!/E Tf�� f�i/ziicN aF yis� di:/rlE:JFJy uJiTi,�in/ T'� C/jr <br /> �i ii.i-�;— c�--w,vy, <br /> �CKNOWLEDGEIdENT OF CONDITIONS <br /> ihe undersiqned ownedapplicant hereby agrees to hold and save hainr <br /> — - -- --j Iess ihe City of Everett from any and all claims for damages, costs, <br /> /� q �/ � I cxpenses, Gr c;wses ef action that may ari=e because of in�tal'ation <br /> �_'���-'� A;.(�_� / ij�o �p and mairtenance ot the imPmvement or othe� righbut�waY u:e herelo <br /> li/ � b U <br /> Approved for Const ction �� Date applied fo and funher a�rees to remove same upon notice Uom thr <br /> / City an o replace pi�c �reperty damaged thereby. <br /> � � � � i ,�17 <br /> FIN�� SP CTION ' __6��e .' l� /„�n� )�����, 2.f!C�� � ��l/ <br /> C_ 6 <br /> 4pprcred as ConsUucted ��S�gnalure App� n �— a e <br /> PUBLIC WORKSDEPARTMENT �ORK A THORIZED BY THIS PERMIT MUST BE �TARTFD WITHIN <br /> e•�^relt �180 DAYS OF DATE PERMIT IS ISSUED APlD TH[RE.4FTEN IS TO <br /> � 3200Cedar Street I BE DILIGENTLY PURSUED TO COMPL[TION. ?HIS PERMIT MAY BE <br /> Everett,WA 98201 CANCEILEf] �Y THC CITY' UPON ANY STOPPAGE OF WORK C1N ThLS <br /> Phonc:259�E3670 <br /> I`!i(L( ��.i liA'CN 90 DAYS DURAIION. <br />