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�B� �� �� PublicWorkSPCrmit• /7� �//�'" <br /> Application For eiee oeo�.• <br /> PUBLIC WORKS PERMIT P��iotelFeafee : <br /> Less Rool Fee Pe�a S� <br /> Print or Type Only eaianceoue s 35 <br /> �� <br /> �� w�-5,�,.��:�� .�,�b�,N� /Zob ' 76i3 -/l3Z� <br /> Owner MaiRng Address . City Zip Phone <br /> l�1 F�r Ev,- ca,�,s.r,Mrs. <br /> � �I�E1./IT tt' ��'�/41� �/t/ORT7f � L�P/1/�7C� �59 --7Z3Z <br /> Applicant Mailing Adtlr s�— City Zip Phone <br /> � DeacribeProposedWork / V F��..L �/Y /j 11�r �vXTlta�C j9l= /ST7'/1(� <br /> � /�[a.,� �'�,Q.a� �4c.c�U o.a( iv�ss.¢r� 7 o R.cc.o� r�x � <br /> � / E � G�/E�5,• <br /> , ,o � W <br /> ; <br /> ; Prolect Address(if known) = � ��-�� � <br /> I� Attach�our 4 co ies of lans lor ro osed work- Draw to scale and nole the followin as a licable: <br /> ( 1 P P P P 9 PP r� <br /> I • Properry Lines � Centerline ol slreet � <br /> i �Outline entl dimensions ol all existing and • Indicate North <br /> � proposed structures on the lot • Show any proposed grading changes <br /> � • Existing and proposed u�ilities • Show measuremenis � <br /> � <br /> DO NOT WRITE BELOW THIS LINE O <br /> � PERMITCONDITIONS <br /> 1.All cells lor Inspection shell be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shell be pertormed in accordance with this permit and currenl City ol Everett Design and Constructlon <br /> Standarda and Specilicetions. <br /> 3.Ceil Location Underground Service 4B hra before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> � ,5���,� �,y S,—���r.r C�E,�,�✓ �r f��� Tm,Es O <br /> ; n <br /> � �t�i �/� / C� b'[� �i.0 _SK�,i Cyl _S e�r'i"�'rt O _7' �-�R9 , � <br /> � <br /> O <br /> a <br /> ACKNOWLLDG[MENT OF CONDITIONS <br /> The unders�qned ewnedapplicanl he�eby agrees to hold:mtl save harm� <br /> �,�� C�e' L}S,c�.rs t%F6i"3�+n' Iess Ihe uty of Pveretl Irom any and all claims for d3mages, costs, <br /> / expenses. or causes ol action that may arise because ol inslallation <br /> (. y� � � /_ 3 J�L�+� and maintenance of the improvemenl or other righ4of�way use hereto <br /> � �� � applied lor and further agrees lo remove same upon notice Irom the <br /> Approved lor Constructi�` ate City and to rePlace PuUlic ProPerry damagetl ihereby. <br /> 7—�3-EG <br /> FINAL INSPECTION Date �� /� � <br /> Approved as Constructed Si9natu� ol Appl Oate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED 6Y THIS PERA9IT MUST BE S�ARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THE�7EAFTER IS TO <br /> Everett,WA98207 BE DILIGEN7LY PUIiSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone.259�8810 CANCELLED BV T!iE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVER 90 DAYS DURATION. <br />