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Date �'18-91 <br />PUBLIC <br />Print or Type Only <br />Owner <br />Owner <br />Applicant <br />Application Fof , <br />WORK� <br />c.� <br />n <br />O <br />S <br />fJ <br />d <br />C�� <br />�� POSTING --�� <br />PERMIT <br />Mailing Address <br />4i)C� t�01'? <br />�S C� tn t7 rj. <br />J] l(1 ..�` G L7 <br />PJ C'J M �`J C�- <br />�-1 ip �.IP '-1 <br />�P Y- <br />u ' ,• <br />(.^. L't �r: 3 C� <br />o u:�u�� W <br />...i .. � o-_ n_ <br />,z� u mn :� <br />Describe Proposed Work attached uaraae 945 SF <br />Project Address (if known) <br />Attach lour (4) copies of plans for proposed woik - Oraw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on ihe lot <br />� Existing and proposed utilities <br />/( 9/ <br />Pu01ic WorMs Permit • `� � / � `TG� <br />eia9. oeo�. • 91/27368 <br />Pu�hc Workg Fee <br />Toiel Fee s ,_ <br />LP55 RpP� FCB Pnid S -7 <br />Balance Oue .i C-� <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells lor inspection sheil be made 24 hrs. in advance - phone 259•881 O. <br />2. Ail work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800�424•5555. <br />'I MAri�MuM D2�vE�v��( �v�o'ru OF Zo�______________.__, <br />5', SAW GUT ovT Ex�STit�lc� G�rt6 �C�urft�lz � iZ� t��GE �v i�t�+ <br />c�TY �T�ND�+Z-r� D��VE\VA�{ SFGTION ,ss t� ���� �3p'1� <br />(ri ,(�,��/E D21VC����{ G'�ZoM PIZoPEtLI-Y I.:.IIJF -�v 6A�K �=lx�E OF <br />5 � OE��iraL.�, <br />/�� �C� N � <br />/� <br />v C�o�''1i'/Pf� , �� 9� <br />� <br />tor Construction <br />(�- z3�9� <br />ua�e <br />FINAL INSPECTION Date <br />Approved as Constructed , <br />�PURLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONOITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City of Everett irom any and all r,laims tor damages, costs, <br />ezpenses, or causes of action ihat may arise because of installation <br />and main�enance d the improvement or other right-of-way use hereto <br />apC�ied for and furiher agrees to remove same upon notice irom the <br />City and ro replace public property damaged ihereby. <br />Qi <br />Uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAT[ PERMIT IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />