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+ /� �S (�� P�LIKWG�k5P9�TI1P ��� ���— <br /> Uate � � . <br /> emv.000��• <br /> Application For <br /> PUBI�lC WOFiKS PERMIT F°°'T�WF�aFeO S <br /> Lass Pppi.Fee Patl $_ . <br /> p. a0 �� <br /> B81p�CC�11? `Y � <br /> Print or Type Only t� m _YG � <br /> , wor k 1��. e- <br /> � �,� � .. � l"�R, ���r'T, ��"z�;� ; �'�-�' ;r,�-� <br /> - - C �T , � �/��. r�r; .� <br /> O�vner <br /> i Mailinq Addres& Ciiy Zip PhonE: <br /> / �7 {1�/ � � �'-77 G!' SG--� v <br /> t��� ��//Z��T'1 /V!%� i .l�/��GL7.�"[('_�J�t�/��(--�� _--�_— <br /> ❑ Mailin Addre55 Crty Zip Phone <br /> n; ant <br /> Dr� .. F"mvoseJWork `�'��-"� ���`tJ��. t\ —_._-_ .— ___--.. — <br /> . . ��F ��in�/yE� /�ic -�C "'iL�G` __— __ _— <br /> --- __ � <br /> - a/o� �,� �rs� ��—_ -- -- t.,. <br /> Proiect Address lit known) <br /> �� <br /> Attach lour 1�I copies ol plans for pr000sed work� Draw to scale and noL^the following as aVplicable: � <br /> �D Properry Lines • Centerline ol sireet <br /> o Outline and dimensions�I all existinc� and s Indicate Norlh <br /> propused structures on the lot • Show any proposed 9�ading changes <br /> • [xistinc� antl proposed utilities �� Show measurements � <br /> ��� s�r� <br /> DO NOT Wi'�ITE I3ELON THIS LWE O <br /> PERMITCONDITIONS � <br /> t. All cabs for inspeclion shail be mace 24 hrs. in advance- phor�e 259•881 5. <br /> 2. A!I work shail 6e perlormed in accordaace with ihis permit anc current Ciry of Everett Design and Construction <br /> Standards and Specificaticns. � <br /> 3. Call Localio� Undergrouncl Servicr.4B hrs. Uelore you dig.TOLI. FRE[ NI IMBER 1-500-424-5555. <br /> ,� � _ i�/ <br /> '� `���'cc,i�/' <br /> 1 �j=?i/C'/�/�T' /Y1C- i �ru>' � <br /> � �� lo' '/G�I�c: C % %c � !��� �'=��� � <br /> f E%% �i ��' p� <br /> V� <br /> i0i�i/86 9�53FiFi DOi)RH�551 � <br /> / <br /> L'i'T.�O :20.00 � <br /> ivRSH ��0.00 <br /> AGlWOWLEDGEMFNT OF CONDITIONS <br /> �I n��undersi9n�d rnvner/applicant hereby agrees to hold and save harm- <br /> less tP�.e Ciry ol Everett Irom zny an� all claims br damages. costs, <br /> expcnsas, or causes ot acilen lhal may arise because of installation <br /> �� --; %' /Gf_/� �'j and rr�aintenance ol the improvement cr other right-o��way use hereto <br /> /�/,-- __ ��/� ��c applied for and lurthar agrees to remo�:e same upon notice irom the <br /> �qpproved lor,�.o ction ��1e City and to replace public pro . �Y dam�9ed ihereby. <br /> , .-� 3l � / -i,�- l�'o?/��'Ki <br />, FINAL I�dSPECTIpN � Date ' Dale <br /> qppro��ed as Consirucled S ature of Applicant <br /> ORK AUTHORIZED BY THIS PERMIT MUST B STARTED WITHIN <br /> cv�•rclt PUBLIC hOHKS DEPARTMENT 130 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUEU TO COMPLETION, THIS PEF���.11i te1�Y �� <br /> Evere�t.WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAG[OF':1C'uK ON THIS <br /> Phone�. 259�f1Fi15 PROJFCT OVER 90 DAVS DURATION. <br />