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p Pu�Lc Workf Parmlt• �y �� <br /> D8�@ Z'7.?J '/r BICp.DeOi.• <br /> Appllcation For � <br /> WORKS PERMIT PuoucWortaFee s . � <br /> PU B LI C Toul Fee <br /> — <br /> Less ApP�Fea Peitl s---�"� <br /> Balence Oue s� <br /> Print or Type Only <br /> A��,�� �i �c� i���� 5� 3g '� $�u�J�� 98007 � �1, s��oq <br /> Zip Phone <br /> Owner <br /> Mailing Address ���Y <br /> � s�`��� 9ft�o7 G�3 3 ���— <br /> nti�r� l'.oU.�,JC �n� �Z''3 City — ZiP Phone <br /> Applicant Meiling Address <br /> R} LoGA-ti"� Dk�JE CuT <br /> Describe Proposed Work <br /> W <br /> 2433 k+�NJ�Ew �C�� ~ <br /> Pro�ect Address(if knownl licable: — <br /> Attach lour(4)copies of plans for proposed work-Draw to scale and note�Ce^�1eWine of stP el N <br /> • Property Lines � Indicate North <br /> • Outline and dimensions ot all ezisting and � Show any proposed greding changes � <br /> proposed structures on Ihe lol � Show measurements <br /> • Ezisting and proposed utililies <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance-phone 259•881 5. <br /> 2, All work shell be performed in accordanr,e wilh this permit and currcnt City ol Everett Design and Construclion <br /> Standards and Specifications. � � <br /> 3. Call l.ocalion Underground Service�8 hrs.before you dig.TULL FREE NUMBER 1•S00•424•5555. � <br /> � � Nll[/ G.n✓ 51C� Pwn_` 1� SeG+.a.-� vtiu��— O h1 <br /> �p�c:w, L'Nr � /� n n <br /> �.X w�.Y re ,�(a-«� w.�-�. c�eP re s S�.Y <br /> be rew�o., � � <br /> C,`N�Gr s�.�..Y C.. rb sec�.�G••� v... .Y ����rWn� .�„QlCh . <br /> � � N m <br /> 1 1 /� �i_ T� 4jo�-�+ cOroKS H .- <br /> �� LOo � df..�tWn \�� 1 C'�wn�TT�"� a -� O N �" <br /> I �t U � , 1; � . � J-�e ex�s�-��� a g� �. <br /> �f no'1" o� .•\ �� 1 <br /> e�no ..� w.a7� be rew�-o.� cY a.�,D re-(J �a�e �.� w ,`r-� � �. <br /> �� � �P�S�� CN� FwY .�Cw S �ekQ..vn. ��t�. � � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS � F <br /> The undersigned owner/app��canl hereby agrees to hold and save harm- � �` <br /> less the City ol Everett irom any and all claims tor damages, costs, y �� <br /> '/� expenses, or causes ol action that may arise because ol inslallation K Y <br /> �y' and mainlenance ot the improvemenl or other right•of•way use hereto � � <br /> �..✓/�..._� 2 �1�_� applied lor and lurlher agrees to remove same upon notice Irom the �T1 ,.• <br /> (Y � E: <br /> Date City and to�Place Public property damaged thereby. <br /> PProv r Co ction � � � C v; <br /> LI -2J�� �ii .n. /�p� .�'-Z3_� � . <br /> Dale Date �c�c�c� �� <br /> FINAL INSPECTION , SignaWre ol ApPlican �5 � <br /> Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEC W�THIN a � <br /> everett PUBLIC WORKS P RTMENT 1B0 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE ' i. <br /> � Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> i <br /> i <br /> � <br />