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i <br /> � �� n�1 O/� �1.Q <br /> Date�L�.� PUGLc Woihs Peprmi�-•� <br /> Application For 8�49 Deol.• .-� � � <br /> PUBLIC WORKS PERMIT �uoTotaFoeFee s <br /> Lexs Appl Fee Pa�C S <br /> �- <br /> BxlanceDua S aO� <br /> Print or Type Only <br /> c�.����0_�i'��• ��i1'1.-�`NDS (,u/-k �'-1 �C�D <br /> Owner Maihng Address City Zip Phone <br /> �� �S �j��—S��`'S �I� � Sf-�G�' �.1�1 l^�JL�� ���L1�11 � <br /> Applicant Mailing Addrass Cdy Zip Phone <br /> Describe Proposed Work � �A � � C-F� <br /> W <br /> ?rolect Address(if known) _���-� - ��lA V/EC� LA� �oT {£S � <br /> o� E�6Einoae. <br /> Atlach four(4�copies of plans for proposed v:ork� Draw to scale and notc the lollowing as applicable: � <br /> • Property Lines . • CeMerline ot street � <br /> • Outline and dimensions oi all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • E�isting end proposed utilities � Snow measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for inspectlon shall be made 24 hra in advance- phone 259•881 5. � j <br /> 2. All work shail be pertormed in accordance with this permit and current City of Everett Design aad Construction <br /> Standerds and Specifications. <br /> 3. Call Locetion Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � I� <br /> T OPT�o.vyL l�.t'ivEwF�y sh'O�✓N oN S�TE �A.c/ NoT O <br /> ' %o �E (JS��O U.VGE6S �GO,Tic,t///G �N�o.f/�ATio� <br /> /S P,�ovioEO To TyE ��/dC�c C..lo�.<S DE,oT, � '� <br /> ( 1.E E9sEmEn�i F�POIr7 6lOjvi,v.vin/G �?c�o.oEcTf/) � <br /> � <br /> ,S ..So/L S .PEf�o.eT {K Tis'iS LOT /s .PEqv�.eEt� O ' <br /> PE^2 PCAT t'a.vO���o�✓f' �F'Fo,e F ,auie o�-vG /� <br /> PE�in�T-r <br /> ,g,PE issv�d , i'� <br /> ACKNOWLEDGEMENT OF COND�TIONS <br /> The�ndersigned cwner/applicant here6y agrees to hold and save harm- <br /> -' — less the City ol Everetl from any and all clsims for damages, costa <br /> / ' expenses, or causes of action that may arise because of instaltation <br /> �jv � �/ .a7 -� `�' y�y g7 and main nance of the improvement or other right-o4way use hereto <br /> —'�1L�/jlejJo�i applied and furt grees to remove same upon notice fr m the <br /> Approved for onstru� �' Date �i(y an t r c publi propert damaged ihereby. <br /> �=/� -i� �.-�t�,` - . � � <br /> FINAL INSP CTION Date � <br /> Approved as Consiructed Signatur of Ap icant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AU7HORIZEO BY 7HIS IT MUST E STAR D WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />