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Date / �/�9G ." - �b�K Wo�«.�n. �o''.�O <br /> Application For Bi°o.o'a. <br /> PUBLIC WORKS PERMIT PuDlk�':m1uFw � _ <br /> Lau Appl Fae P��O � <br /> Print or Type Only B�NnaDue t�//O d� _t' <br /> /�1o��AT l�,�o�p /��s��L� Av� sE T��� P'e��1 ��.�r � <br /> Owner MaiNng Atldress City Zip Phone <br /> LL1lc.s�vctest, <br /> �N� f�o�.t�i x ��rovP, irtt� /i �. �� /� <br /> Applicent Mailing Address City ZID Phone <br /> Deacribe Proposed Work /�[Z7'/Q.lp��F NI D�/TlOi(! WoR l� �'F�uiR�4 f�_ <br /> Pl.�r �a���' � � .rz���P�r���--��t1��r <br /> ProjectAddresnQfknown) 1�1� /�'tf�/.fT. -.��Yl"r_ � <br /> Attach four(4)copies of plans for propoeed work•Draw to scale and note the following as applicable: � <br /> • Property Lines � •Centerline of street � <br /> � Outline and dimensiona of ell existing end 1 Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing end proposed utilities • Show meesurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection ahall be mede 24 hrs In advance-phone 259•887 5. � <br /> 2. All work shell be pertormed in accordance with this permil and current City of Everett Deaipn ancl Conetructlon <br /> Standerds end Specificallona <br /> 3. Call Location Underground Service 48 hra before you dig.TOLI FREE NUM ER 1•80,,,0(-424•SSSb. � <br /> �l INkE�� '� � � "� � 0 ✓ Nn('— '� fN � 0 1` �'U.�( ysTEIL <br /> ,r l� � P,,, FAsr sr dt ., � ,,��� Ey 0 <br /> �uH�1T�'� � �/� <br /> ' y L S Vr <br /> �� ; �-J i � <br /> � , � � <br /> s� e r����k` a <br /> 2�,� ,�� @.v wts9' <br /> s� d� �}' A�4y ����1 <br /> CAv34.. f5rr2lH�i ��'W(ti . <br /> � ACKNOWLEOGEMENT OF CONDITIONS <br /> h 4x "¢'d The unders:gned owner/applicant hereby aflrees lo hold end aeve harm- <br /> � � less the City ot Everett from eny and all claims for damapea, cost4 <br /> expenses, or causes ot ection that may erise because of Installetio� <br /> �� -?l� and inaintenance of the improvement or other right-of•wey use hereto <br /> Approved r�o� � Date aPPiied for and (uAh=r egrees to remove same uPon notice from the <br /> City and to re public property demaged thereby. <br /> _ 2 10-�L � ��t•� <br /> �FINAL INSPECTION Date <br /> Approved as Constructed nature of Applicant Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PI:RMIT MAV BE <br /> Phone:259-BBt 5 CANCELLED BY THE CITY UPON ANY STOPPAOE OF K'ORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />