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f�. <br /> — ) '�. <br /> e'T' y� <br /> f ' <br /> Y.. M_NV� <br /> F�y <br /> . � <br /> ��.��� . .. ..,<�, <br /> � � _ ..,; � <br /> ��� �9 � � <br /> ro�� ' Date��E`� n�roi��wo,�s r�.m�i. —.._ <br /> Application For eina oeoi • _�Q --L..3-.�� _ <br /> ��� PUBLIC WORKS PERMIT °°°°°w°��°`�.a ------ -- <br /> . lotelFee S <br /> �d Leas Anul Fee PaiU S <br /> � � j Oniancr o�n S �0� � <br /> � � Print or Type Only — <br /> �H <br /> y 353 — z <br /> Hy S�a✓Pn G 7nn�� _f�i l�7 {�a.-�c /�r �vprP�- �zo3 1 � <br /> ��„� � Owner Maihng Atldress City Zip Phone <br /> ��r�I <br /> W ' <br /> ,,a } Applicanl Mailing Atltlress City Zip Phone <br /> __ d r <br /> Describe Praposed Work ���� 'QDU����✓ <br /> I <br /> /.. W i <br /> ProjeCt Adtlress(if knownl /–i � 5 �Qr�" ��� � � � <br /> Attach lour 14)copies ot plans for proposed work-Draw to scale a�tl note Ihe lollowing as applicable: � <br /> \' • Property Lines • Centerline ot street � <br /> '. • Outline and dimensions ol all ezisling antl • Indiwte North . I <br /> proposed siructures on the lot • Show any proposed grading changes , <br /> .� • Existiny anC proposed utilities • Show measurements M �. <br /> !`��`�'rl� DO NOT WRITE BELOW THIS LINE � �, <br /> ; O <br /> i PERMIT CONDITIONS <br /> 2 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> � a 2.All work shall be pertormed in accordance wilh this permit and current City of Everett Design and Construction <br /> !!! ' Standards and Specilications. <br /> , �� 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � I <br /> � i O <br /> �� � <br /> I � <br /> � ���� 12/11/B9 4:18PM OOORN9128 � , <br /> / <br /> IID0023315 <br /> , e�nc sii7.00 a <br /> PI 'I CH f11.70 <br /> � ��'�� 6 S�CtI f4.50 <br /> DRVW'1 f20.00 <br /> CHECl: f153.20 , <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> _� The undersigned owner/applicant here6y agrees to hold and save harm- <br /> Iess the City of Everetl irom any and all claims lor damages, costs, i <br /> eMpenses. or causes ol action Ihat may arise because ot installatlon <br /> f//�7 �y � ✓�G� „ //�7_� and maiNenance ol ihe unprovement or other rigM-o�-way use herelo <br /> �(�,�//� F-eJC � applied lor antl lurther agiees to remove seme upon notice Irom the <br /> Approved lor Consir Z11on Dale C�ty and to replacepubry propert amayed there6y. <br /> ��%/ _ � <br /> ��,_��'a �� <br /> FINAL IN�`CTIO� Dalc � •'� /�—�/ � �I <br /> Approvr.d as Construqed SIgl,alute of Applic P � Dale � <br /> evr�i�lt PUBLIC WORKSDEPARTMENT WORK AUTH ED BV THIS PERMIT MUST BE STARTED WITHIN I <br /> 3200CetlarSiroet 180 DAYS F �ATE PERMIT IS ISSUED AND THEREAFTER IS TO i <br /> � O Everett.WA9R201 BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMI�i MAY BE <br /> Phone:259•BB10 I CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK O�THIS i <br /> PROJBCT OVER 90 DAVS DURATION. <br /> � <br />