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�81@y.�yy r�pncwa�tsre�mn. ���_ __ _ <br /> / • / -.. p� / <br /> ApplicaliDn For eiay oeo� • �(J.J��� <br /> PUBLIC WORKS PERMIT P�����W�«,F9G � - <br /> ,o�r�F�� s <br /> Less Aooi Fee Fam 5_ <br /> � <br /> � paianu�Oue $ ��� <br /> Print cr Type Only <br />�' �v�l'� �KtP.1. l �Q.S /�l'L�/r��l.l�'�rC2.. C✓��Jt`� Ju�o�?3 <br /> t` Own� MailmgAddress Gfy ' Zip Phone <br /> t ���,S��Z�..���-7d S.� �vaia�/Yloi//�.� M�a�LY� ���� GS��� <br /> Applicant Mailing Address City Z�p Phone <br /> Describe Proposed Work ��/�A � /��/]�(��jl�l�V � rT��,�/�0� <br /> 9 ra�g<c.� W <br /> ProjectAddressf�lknown� oc.�/L i�n P'� � <br /> Attach four(4)copies ol plans br proposed work� Draw to scale and ote the ng as appficable: � <br /> � Property Lines • nterline ol sireet � <br /> • Outline and dimensions of all existin�and ndicate North <br /> proposed siructures on the lot • Show any proposed graAing chanyes <br /> • Existing antl proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS L�NE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> i Standards and Specificetions. <br /> ' 3.Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 1•800-424•5555. � <br /> � �. ALG NE(�/ P�Q��/N� 57AdL5 SH�t_[_. AGL655 �-�7I>C/�t..t_L"y <br /> A�i/O MA�Y �EQvi2E /k i2ETi�liNiNC� /�l�L�- . O <br /> S, EX l 5%/NF, S/pE SELJE� �lffYLL P,x-- �EFZ-AC�:v C�J/7�1 N EW � <br /> (o �� L /NC. � <br /> - ��� O <br /> �, � �, a <br /> ,��'� �`�� <br /> �:�- <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersic�ned owner/applicaM hereby agrees to hold and save harm� <br /> — less the Ciry ol Everelt I�om any and all clalms for tlamayes, costs. <br /> �� �t,. expenses, or causes ot action Ihat may anse because ol installation <br /> iyi�'//_„ //� / antl maintenance of the improvement or oiher ric�hbobway use hcreto <br /> /�[ l�/L�L <br /> Approved for Consiruction ��e applied for and further agrees lo remove same upon notice Irom Ihe <br /> Ci�y and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED VJI7HIN <br /> � 3200CedarStreet iR0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA9B201 RE DILIGENTLV PURSUED TO COM1IPLETION. THIS PERMI7 MAV 5E <br /> Phone:259�8810 � �,��NCELLED 6V THE CIiY 11PON ANY STOPPAG[ OF WORK ON THIS <br /> I`r0!E_C;i OV[R 90 D.11'S DURA i ION <br />