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a <br /> . <br /> Date.� '�—`�S� a�m��wo�wsre.mu. c'J�B—ZG��o <br /> ' ApGlication For BIEB Dept.s <br /> PUBLIC VI�ORKS PERMIT PunTc�iW(��Fee S <br /> Less Appi Fee Paitl $ <br /> Pfint Or Type Only ea�a��e o�� 5 20� <br /> �'C��� T Y P. ;C !,'/�Pr�S .1r Cnin �o�/aFo����t FvE/� iT 9��0� 15.� .�5' 3 <br /> Owner Mailing Address City Zip ph�� C �. „^ <br /> c�.�Q <br /> ��m� ��S 38a <br /> Applicant Mailinq Address City Zip Phone <br /> Describe Proposed Work � E ✓ c � �'f�'��/NG _C T,� i p <br /> Projecinddresa�ifknown) a������ �5 JAC.C.'.SO/L� EUf.ef// C�IA- 1�/';,LO� � <br /> Attach four(��)copies of plans lor proposed wo�k- Draw to scale and note the following as applicahle: � <br /> • °roperty Lines • Centerline of street 'w <br /> • Outline and dimensions ol all existing and • Indicate North V� <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Ex��sting and proposed utilities • Show measurements � <br /> �-� DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 7.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with Ihis permit and curreN City ol Everett Decign and Construction <br /> Standards and Specifications. <br /> :�.Call Location Underground Service 48 hrs.before you di�.TOLL FREE NUMBER 1•800•424•5555. � <br /> � ,,��i��a�� c� �e o�u.�G��a�./u.-� o�� — O <br /> �a 6a.c:,�=� �-u-� oh�'a � �4�� <br /> � <br /> -s .�� ��C�.�u��'.,Cc ���-�.��;z� �� � c�'� � <br /> w�� �� �� ���.� � ��z��� Q <br /> �U�.t ,�j-� S,J.i,ec�iZ, af �s�-l��o� ,�ey42�-� .�e�[c�v�� . pi, <br /> ACKNOWLEDGEM[NT UF CONDITIONS <br /> The undersigned owneNapplican�hereby agrees to hold and save harm� <br /> iess ihe City of Everelt Irom any and ail claims for damages. costs. <br /> ' expenscs, or causes of action ihat may arise because ol installation <br /> `-� � �v � G �g and maintenance of Ihe improvement or other right�of�way use hereto <br /> applied for and furiher agrees to remove same upon notice Irom the <br /> ApproveA lor Construction a�e Ci1y and to replace pu6iic prope ty damaged lhereby. <br /> i <br /> ///�, / J: // 7 <br /> FINAL I�CTION � ��3 D te �t f--f l ",�/ , / � �~ ,� - ,G` _S�=��, <br /> ApNrOved as Constructed �g�ure ot Ap�t Dal�� <br /> evere[t PC9LIC WORKS DEPARTMENT WQRK AUTHORIZED 9Y THIS PER�d1T MUST BE STARTED WITHIN <br /> � 3200�adarStrcet 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DII_IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8010 CANCELLEU BV TH[CITY UPON ANY STOPPAG[OF WORK ON �HIS <br /> PROJ[CT OVER PO DAYS DUHATIUIJ. <br />