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-- � �, <br /> p�) '�� /�/ b`� ' <br /> e� 1 � � ( Ja9.3 � <br /> D�te�lL / � v ' �'l� . ' PUEIk WorMs Per s _ <br /> - � � 3� <br /> AOPlicatlon For eiau o.m..� <br /> PUBLIC WORKS PERMIT Pu0licWorlwFaa <br /> TW�IF�� _ <br /> U�a I�ppl F��P�itl j /���j <br /> B�I�nce Ous S�� �'�� <br /> Print or Type Only — <br /> ��u� l��e c�. Nd.� l�1'// - �3� .�- C��-�' ��d�3 35''7-/s.3� ! <br /> Owner Nailing Addreas City Zip Phone � <br /> � <br /> � � <br /> Applkent Mailing Address City Zip Phone <br /> De�.:ril'�P�oposed Work 1�2-e^� � � C�»�.�+-� /la-+c-�'e"e�....e.--V <br /> ProlxtAdtlrees(ifYnown) .f� �� ��1LL�er. �/'iE'i— `✓4V � <br /> Atlach four�4)copiea of plans lor pr�k- Draw lo scale ar.d note the following as applicable: � <br /> • Property Lines • Centerline of sheet � <br /> O Outline and dimenaions of all existing and • Indicate North <br /> proposed structurea on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1, All calls for inspection shall be made 24 hrs ir. aav�nce- phone 259•881 S. � . <br /> 2. All work ahell be perlormeA in eccordance with this permit and current City of Everett Design and Construction <br /> Standards end Specificatlona <br /> 3. Cell Locetion Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> f�� 1.f/STQLL ASvri'd L T /CpiYc,e_-'.E7-E L�/!iE/.t/p t!I � <br /> (ST•e6ET 70 ��GyT-OF- Wd)/ G/�E� <br /> � CLEaii/ ��T G�iCliE27 i1T SOuTf/ EN� �'� � <br /> �.eu.�T•aGE- � <br /> O <br /> � <br /> ACY."NOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � � � less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of instetlatfon <br /> lO�� and maintenance of the improvement or other righ4of•way use hereto <br /> applied for and IuAher agrees to remove same upon notice irom th5 <br /> Approved for Constr n_ a�E City and to replace public property damaged thereby. <br /> 1 <br /> --��, L(v � � .,.�lP � � /4 � <br /> FINAL INSPECTION Date ��- � � - <br /> Approved es Constructed Signature of Applicant ate <br /> � WORK AUTFiORIZED BY THIS PE IT MUST BE START WITHIN <br /> everett PUBLIC WORKS DEPAfiTMENT 180 DAYS OF DATE PERMIT IS ISSI�ED AND THEREAFTER IS TO <br /> 3200 Ceder Street BE DILI�ENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,\YA 98201 CANCELLED BY T�iE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � Phone:259•8815 PROJECT OVEF 50 DAYS DURATION. <br />