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„ <br /> -"'1 <br /> , _ <br /> _ --� <br /> D8t@ �� � L PUCIic Warks Permit• <br /> a.+_ r <br /> BIEq.DeO��• <br /> Applicatlon For <br /> � PUBLIC WORKS PERMIT P�bIlcWorkaFea <br /> ,� To��l Fe� s <br /> � Lens FpPI F!t PlIE S <br /> � B�bncs Due � <br /> Print or Type Only <br /> � ` `1���`'t �� o�l/)�i1�F -� � ���—s�?��� ' <br /> � ~ Owner Meiling Address Cdy Zip Phone <br /> 1 � <br /> � pplicant Mailing Address City Zip Phone <br /> I Oeecribe ProP sed Work 'v�D TV ��!r� �n �j�'L� �AiE'�/��n ���'�� <br /> 3 3 <br /> W <br /> Project Address pf known) ��v� � ���N "��'`�S . ~ <br /> i �� <br /> � Attach four(4)copies of plens for proposed work• Draw lo scale and nole lhe following as applicable: � <br /> . • Property Lines • Centerline of street <br /> � • Outline and dimensions of ell existing and • Indicate North <br /> � proposed structures on the lot • Show any proposed grading changes <br /> ' • Existinp and proposed utllities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> � PERMITCONDITIONS <br /> 1. All calla for Inspection shall be mede 24 hra in advance- phone 259•881 5. � <br /> i 2. All work ehall be petformed in accordance with this permit and curre�t Ciry of Everelt Design and Consiructlon <br /> ' Standards end Speciticationa <br /> 'I 3. Cell Lxetlon Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � �: S'��e wa��i w i/! ✓��++a� n c %c. r- O <br /> i , . / • <br /> S: �,�i v�n 9' �cc►, eS S �a!� r-ch'� a i +� L �4 r, <br /> � 1� � � / / � <br /> � / �(O. -2Y/M � G Va �r d ��.Y'� (� 22 - Z�e o n �. . � <br /> 7 �.�.✓ a�P �ai.e� /�/n �u.�ed 3 -.�'84. �i <br /> ' ' a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> , The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everetl from any and all claims for damages, costs, <br /> , , expenses, or ceuses of action thet may ariso because oi instellation <br /> and maintenence of the improvement or other right•of-way use hereto <br /> � applied tor end further agrees to remove same upon notice irom ihe <br /> Ap rov o onsiructio Date ity and to�ace puhlic property dameged thereby. <br /> ' ����. 3-��� / ` � �� . � <br /> AL SPECTION Date � Date <br /> Appro ed as Constructed Sign re o Applicant <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS .O <br /> � 3200 Ceder Street BE DILIGENTLY PUFiSUED TO COMPLEI'ION.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 />