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D8t@ PueLc Worka Permit e _(,_��z <br /> Applicstion For Biep.Deot.r <br /> PUBLIC WORKS PERMIT P��,a,��•°� , <br /> Lee�Appl Fee P�iC f <br /> Print or Type Only BH�nceDue s �a pe <br /> 1�/G/IA.�'G> 89RcLA�/ E�E,e�c'�J' js3 ��„f��f <br /> Owner � Ma�Hng Address Cdy Lp Fhone <br /> ��9y'r�no� 1�E� Sivs- i <br /> ,3"dAc��r_/ E,�E,�F� 9a��a.3 .�s�'- 08.9/ � <br /> �PP��Cent Mailing Address City Zip Phone <br /> Describe Proposed Work C��s%�'/JGT S/iYGCF Fi?�y ��r _ 1 <br /> � <br /> - Wi <br /> Pro�act Addreas Qf known) �6/6 - i - L q,r/ � i <br /> Attech tour(b)coples of plana for proposed work• Draw to scale and note the fo�lowing as applicable: � <br /> ! Property Linea • Centerline of street <br /> • Outline enA dimensions of all existinp and • Indicate North <br /> propoaed atructurea on the lot • Show any proposed grading changes � � <br /> • Exlgtinp gnd proposed utilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calle for inspection ahall be made 24 hrs. in advance• phone 258•681 5. � <br /> 2. All work ahell be pertormed In accordance with this permit and current City of Everett Design and Consiruction <br /> Stendards end Specificalions <br /> 3. Cell Locatlon Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 7-800-424•5555. � � <br /> J� �O.tIS%G'UCr �.t/ fISPf�ACT DRii�E<<1?�/ WiTi7/ /9 CGd'/7f�•iC0 I <br /> vF,�;.� of �.vn r,vay�s �� -� of- �vs�Q�T �vF,� .9 � ; <br /> C,e�is�F� �'oc,r c?ps� Ttl 9 sv�n,-� af isr�f.- <br /> � � <br /> � 1 <br /> O � <br /> a � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS y <br /> The undersigned owner/apPlicant hereby agrees to hold and save harm- � <br /> less the City ol Everetl irom any and all claims for damages, costs, �; <br /> �� ///� � eapenses, or causes of action that may arise because of installation <br /> �i .�OtN"r�� � /y/� and maintenance of ihe improvement or other right-oFway use hereto <br /> Approved for Co struction - aPP�ied lor and further agrees b remove samr. upon notice from ihe <br /> Date , �{�y and to rcplace pu lic property damaged thereby. <br /> ��( �� , <br /> ���y�� �— � 3 -��' 2� / � <br /> rFlNAL INSPECTION Date 7 � "� <br /> Approved as Constructed Signature of pp t <br /> Date <br /> everett PUBLIC WORKS DEPARTMEIJ7 WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 320G Cedar Siraet 160 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br /> Everetl,WA 98201 BC DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8815 CANCELLED �V THE CITV UPON ANYSTOPPAGE Of WORK ON THIS <br /> PROJECT OVFR 90 DAYS DURATION. <br />