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".' <br />loft do, <br />I <br />IML Am, <br />;�*.t- w <br />.1. .r.i <br />�; Application For <br />PILIC WORKS PERMIT <br />y O <br />Sf. O <br />Print or Type ont .. o' ca 0 !C1 0 9 oC-i TO POSTING L9 z <br />M Nt .NY .- e1 C t _ <br />M _ t� <br />co c. o +.row <br />0 05 /-- fJ � i'- <br />Mailing .Address <br />Describe Proposed Work <br />Project Address lit known) <br />City <br />Zip <br />Zip <br />Attach focr (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />Public works Per(9, t Q�O�s ��-��i <br />Bldg peel • _(l1ZIr/—L-F-� _ <br />Public Works Fee : <br />Tolnl Fee <br />Less spiel Fee Paid f <br />Balance Due <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />W <br />H <br />U) <br />Im <br />O <br />n <br />z <br />O <br />/ L.J-Sit/ny fa QCCDmnrO�nfC 7Z�iS vise. 0 <br />47, fin '6 %3rc'�Fa rr n.^ n !/4�� (�/O <br />}/_ mar�¢O� Sio�ec✓aC,E- ShnLL 6c <br />�J4i�ac>//rL^�cncao� /Jar Me e;"y woe.,Es <br />7 /i fiQc ys✓atrr valve -"us/ 6e 1�st4LLecl Six fhe <br />S/�% Bearer, <br />ACKNOWLEDGEMENT OF CONDITIONS � O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-ofway use hereto <br />�70c+/�2 applied for and further agrees to remove same upon notice from the <br />Approve r Construction Date City and to replace public property damaged thereby. <br />FINAL INSPECTION Date - <br />Approved as Constructed Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />evereu PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE nF WORK ON THIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />7, JIle WOrF rev ��er.L��evnc �ee c �i2 4)6'4"S <br />12 IV fled Oh4Zfa.c0uri> <br />5 /v/Q%Gr SZi C/�f fp 7`/J iS �Lxi (cy i/ r�i <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3, Caxefion Underground Service 48 hrsbefore you dig. TOLL FREE NUMBER 1.800-424.5555. <br />I/ <br />�17f Q it el <br />f U� <br />b� <br />it <br />