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Date Z � 4 <br />qpplicalion For <br />pUg��C WORKS <br />Print or TypE Onl) <br />Ken PScCallister <br />Describe Proposed Work <br />G—i � ZP� S <br />�+ <br />PERM <br />T� STING 5-��- <br />O N <br />pp Bor. 3G06 Everett 98204 <br />ng <br />000011']UO� <br />S . <br />N M p O 3 O N <br />�: V/ M M� ��p <br />'+ _ _' M__,. <br />� r^.}G�tv x(� �' <br />o��[T..l�u��J <br />�d�,a'�Simoa <br />City Z <br />�/ <br />Pu��ic Wods Pe� 4346� Z <br />Fidp. DeO��• <br />�� <br />PUEI¢ Woiks Fae s -- <br />Tola� Fea <br />=eaa POc� Fuc Paid S —�— <br />w�arsaRra ' <br />� N O <br />M`O � <br />N M <br />� pho�e <br />�i � <br />N W <br />� N U <br />� Phone <br />-- -� , ,� �,�� �„� �� -�►,� <br />Prolect Address (if known) <br />Attach four (4) copies of plans tor proposed work • Draw to scale and nole ihe following ai aPPlii able�. <br />• Property L�nes <br />• Outline and dimensions of all exisling and <br />proposed strucWres on the lot <br />• Existing and proposed utilities <br />• Cenlerline o s ree <br />• Indicate North <br />� Shou+ any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells tor inspection shall be made 24 hrs. in edvance • phone 259�881 • <br />2, All work shell be performed in eccordance with this permit and current City of Everett Design and Construction <br />Standards and Speci�ications. <br />24•555 . <br />3. Cail Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1'� 5��� <br />r,���- � yr•�d.� � r-� <br />�( , '�o,M,c,�G ex�1� a � P � �oa-dt�+a,kx �✓�''r ►�" w i -ih <br />,.�,o d.rq,�v� vw r-l�� �O G B <br />�� �ns��to�' 33q��". <br />(.i3Q� Bx�s�,.,5 we�c�� �� <br />,iad rf�51��a,.c�. n(ew sa��;�e <br />�nr liao lilsb/o�, o:..�� <br />// /Ii�— <br />O� <br />qpproved as GOnsvuc�eu <br />����`� PUBLIC WORV:S DEPARTMENT <br />3200 CeAaf SlreBl <br />Everett. Wh 98201 <br />Phone:259�8810 <br />W <br />H <br />� <br />� <br />f'� <br />O <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the G�tY ot Everelt irom any and all claims tor damages, cosls, <br />expenses, or causes of action lhat may arise because ot instailalion <br />gppl edl�oe Bnd �urlhe�,09�Qe5 l0 remove' ameu Pon' nol cestromrt e <br />�Iry and to replace Public p�oPerry damaged thereby. <br />.?� _� � _ C <br />� <br />C Date <br />ature � plican <br />W RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI <br />18 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS Tn <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PROJECT OVER 90 DAYS DURATION. STOPPAGE OF WORK ON THIS <br />