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t <br /> � <br /> , <br /> '. ` — Z/�,� <br /> p�� Pu�hc Woike Permll s � <br /> Date��y.. ��_ <br /> Application For Biaq.Dact• O <br /> � PUBLIC VUORKS PERMIT P°°:a�aFaeGBe s <br /> Less AoOI.Fee va�e S 'J <br /> Balance Dun f `_nO O <br /> Print or Type Only <br /> ' Ska.►,e W1Al�v� P ��Di a�ne .St �.�eieN- 9��0/ ,�s�i -34ZS <br /> � <br /> � Owner Mailing Address Ciry Lp Phone <br /> �pnMa WJ 1- lG 5a. l�-I r �1G N 9 L-✓�nwo� 9 R Q37 7�./3-/S�z'S <br /> � Applican! Mailing Add ess City Zip Phone <br /> � � I�N l�Cl�� ���O14�1 <br /> Describe Proposed Work <br /> � <br /> ; <br /> i W <br /> � �[� sf <br /> � Project Address(if known) {�Q � ��YI P � <br /> 1 <br /> � Attech four(4)copies ot plans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines � Centedine of street � <br /> 1 • Oulline and dimensions of all exisling and • Indicate Norih <br /> t proposed structures on the lot • Show any proposetl grading changes <br /> ? • Existing and proposed utilities • Show measurements � <br /> { DO NOT WRITE BELOW THIS LINE <br /> � O <br /> j PERMITCONDITIONS <br /> . 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> - 2.All work shall be pedormed in accordance with this permi;and current City of Everett Design and Construction <br /> � Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1••800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> � a <br /> ( ACKNOWLEDGEMENT OF CONDITIONS <br /> �`� The undersigned owner/ap�licant hereby agrees to hold and save harm� <br /> less the Cily ol Everett irom any and all claims for dama9es, costs. <br /> � expenses, or causes of action that may arise because of installation <br /> � ` /�/, � � s . � and main�enance ot the improvement or other righbof-way use hereto <br /> ` CG ��7 applied lor and luriher a�rees to remove same upon notice irom ihe <br /> Approved for onstru tion �a�e City and to replace public properry damaged thereby. <br /> �/' � � . 5,/ � F'o2 g—� <br /> �� Date Ler� LaCourl�e� � �'}��,.� <br /> FI AL INSPECTION " L Dale <br /> Approved as Consiructed Signature o Applicant <br /> WORK AUTHORIZ.ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br /> Everet4 WA 98201 CANCELLED BY TViE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />