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��� � <br /> � <br /> Q�j�..I'3� ' - . , � — /_�sU <br /> �„��� �8�0 �`��_/�� P�oi�c wa�wc Fe,mit 1 l � <br /> �' � �� � <br /> k p Applica�ion For eiap oro��•��� <br /> �M� PUBLIC WORKS PERMIT �°°;o,�„FQ„°°° s <br /> � Le�snoo�.FvePa�a S <br /> 0� <br /> ��oy Print or Type Only ea�a��e o�e s 3S <br /> OM <br /> p� �-l�'� ��r���--� r�i� i�r-�X 8�c`� �� r���� ����,��� ,����'�-���%� <br /> �y� Owner A7ailing Adtlress Ciry Zip Phone <br /> L" <br /> �H h u <br /> �y~ App�icanl Mailing Address � � Gry Zip Phone <br /> a`r� <br /> y�p DescriCe Proposed Wark _�y.,_������n�/1 ` �T���`�" _ <br /> _ 6 f/1 •—� ��U/' .�.e.�'/��� rl/E'.F�.�--� <br /> Project Address lil knownl / ���G �'���/ ��— � , <br /> Atlach lour(4)copies o�Plans lor propused work-Draw lo scele and note Ihe following as applicable: �� � <br /> • Properry Lines •Centerline ol street /A <br /> •Outline and dimensions ol all existing antl • Indicate North V� <br /> proposed stmctures on the lot • Show any proposeA gratling cna�ges <br /> • Eaisling a�tl proposed uti�ities • Show measurem�nts � <br /> DO NOT WRITE BELOW THIS LINE O <br /> � � PERMIT CONDITIONS <br /> '�t � 1.All cells for inspect�on shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with Ihis permit and currenl City ol Everett Design�nJ C.onsirur.;ion <br /> ' ' Standards and Specitications. <br /> � 3.Call Location UndergrounJ Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> '�t 0.7.�30/90 10:39RM OOOFiN0760 <br /> / O1100023873 <br /> ��' 6iDG E630.50 <br /> ' i PLN CH 556.50 � <br /> E SRCH 54.50 <br /> ' Df`iVfJV 435.00 � <br /> CHECI( l726•50 O ' <br /> � <br /> �_I _ a � <br /> � _ � <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> The untlersigned owner/applican�.bereby a9rees lo hold and save harm- <br /> `� less the City of Everetl irom �ny artl all claims lor damages, coslf <br /> •.,� ezpenses, or causes ol acliop Ihat-may arise because of inslaltation <br /> i_' ^� � /> �_��G� and n�miena ce ol Ihe�mprbvement or other rig�4ol�way use hereto <br /> �_ y�� <br /> applled for an lurther rees lo remoye same upon notice trom Ihe <br /> _ .. -. Approved lor Construction Dale CIify antl to t place publ� pro erty damagetl thereby. <br /> \ <br /> �_. <br /> L' /��"�'� <br /> FINAL INSPECTION Datr. — <br /> Approved as Constructed Signature Appli aN �2�P <br /> WORK AUTHORI �ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKS�EPARTMENT t80 DAVS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200CedarStreet BE DILIGENTLV PURSUED TO COMPLETION.THIS PERbili M��Y BE <br /> Everett'NA 99201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON iHIS <br /> Phone:259�A�10 PRO,IECT OVER 90 DAYS DURATION. <br /> i <br /> I <br />