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, l <br /> (� � <br /> �Date✓ �� ^ Publlc Worke Permit• � / <br /> Applicullon For BitlO�Deo�.�— �._._9__2-_ <br /> PUBUC WORKS 1'ERMIT P°°4o,aFee�e� s �'o--- <br /> Lese ApO�Fee Paltl S <br /> Print or Type Only BalanceDue l���' <br /> �. ��, (��, �oi lveTyv�v�e ��� EU. 9BL� 1 154- 7�51 <br /> Owner Mailing Address City Zip Phone <br /> �✓, �o�, Ce� SAtiue <br /> Applica�t Mailing Address City Zip Phone <br /> i <br /> Describe Proposed Work �r' �2�UC IA.'l.li iND•�z� p�A.J L n C A CXJ <br /> Prolecl Addre:s(it knowrq ��v � y/C�'`� �L��_ � <br /> � <br /> Attach four(4)copies of plans tor p�oposed work• Draw lo scaie and note the following as applicable: � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • In�iicate Norih <br /> proposed structures on the lot • Siiow any proposed grading changes <br /> • Existing nnd proposed utilities • Show measurements � <br /> p0 NOT WRITE BELOW THIS LINE O <br /> PGqM1T CONDITIONS <br /> 1. All cails for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be perfonnEd in accordance with this permit and current City of Everett Design and Consiruction <br /> Standards and Specifications <br /> 3. Call Locatlon Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> }! �E'iYlar� .F�C/o�ri�G c�J�t'«'L=�,v�Y ,cr ,E�P�Ac� O <br /> ( <br /> �;JiTiY �—/ C�•err3 f G ur�,� �� 5���-J9�: <br /> .ST/tNU4 :/ ..�oS �'30� � <br /> S' ,✓C�.v c�,Pi��.�s;� :'.� C��I �s�-,�o�� �c�7 V� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to ho�d and save harm• <br /> // iess ihe City of Everett irom any and all claims for damagea costs, <br /> � y�i,'~`!� , �J exPenses, or causes of action that maY arise because of installation <br /> �� and maintenance of lhe improvement or other right-ol•way use hereto <br /> !-���,�x'— < � applied lor and lurther agrees to remove same upon notice from the <br /> Appr9detl lor Constr t on Date City and o replace public property damaged thereby. <br /> �%GE-��C L oSEO �J�>T ,�5���$6 I <br /> I 7�r <br /> FINAL INSPECTION Da�e GG�� �L ' � a"r' / � <br /> Approved as Constructed SlgnaWre of Applicant Date <br /> PUBLIC WORK3 DEPARTMENT WORK AUTHORIZED BY THIS PERMIT ST BE STARTED WITHIN <br /> everett 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 OF WORK ON THIS <br /> Phone:259-8815 PROJECT OVER 90 DAYS DURATION. <br />