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�f Pubi�c Wods Peim/)it� <br /> DBtB ~ � BiEG.Deoi.• 3� �ifZ �_ ��— <br /> qpplicetion For <br /> PUBLIC WORKS PERMIT PuoTo�feeFae s <br /> lens�o��Fee PaiO S <br /> B�lence Dae 5 <br /> Print or Type Only <br /> �ENieYC O � ✓� /NC� � `f �LGSF�FNG w�Y� CYNN:.JODQ � G/A •`'��0.7L J���a.7 �� <br /> Owner Mailing Address City ZiP Phone <br /> i��I"7L' <br /> l�pplicant M:.ilingAddress City ZiP Phone <br /> ENccOS¢ F�ONi PO�CN � I�C41rRR � t /JU /NST/��'- TO/�-n- � �- <br /> Descrbe Proposed Work i —' <br /> r �f w �J 11 d v.S � � PF� Y Nh W i0/z Y �✓ �c. � <br /> LAY/�i 02 � 12aP:-ACO ' <br /> W <br /> Prolect Add�ass(if known) <br /> l o PFI� i�=i� vt . Ed2,e�rr � <br /> � <br /> Attacn fou-(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> � Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> p�oposed structures on lhe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show moasurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for inspection shall be made 24 hrs. in advance� phone 259•881 5. � <br /> 2. All work shell be pertormed in accordance with this permit anA currenl Ciry of Everetl Desiqn and Constniction z <br /> Stenderds end Spedfications. � C <br /> 3. Cel�Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. F <br /> � <br /> � v O • <br /> '//�� � � � ' , � � � <br /> I� V- �/ /�' � y � <br /> V ��`' '' Q� /1 � �� <br /> / <br /> �/ � � � I ) � 0 � � <br /> / � y � <br /> / � � � � � a � <br /> � � � <br /> � <br /> � � : <br /> ACKNOWLE GE� EN OF CONDITIONS � 4 <br /> The undersigned owner,applican'her by agrees to hold and save harm- � �� <br /> less ihe City ol Everetl hom any a d all claims for damages, costs, , <br /> expenses, or causes of action thal ay arise because of installa!ion OO .., <br /> and maintenance ol Ihe imprqvement or other righbof-way use hereto . <br /> applied lor and fur�her ayrees �o remove same upon notice from lhe � ; <br /> Approved for Consiruction Date City and to repla public proFerty damaged thereby. , <br /> (/ r <br /> % / ..� �. '� ����i�S�- �� F.. <br /> FINAL INSPECTION Dale , ' - � ;. <br /> � Date <br /> Approved ae Consiructed Signatu� A plican� i <br /> WORK AUTFiOR12ED BV THIS PERMIT MUST BE STARTC-D WITHIiJ : <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PfRM1T IS ISSUED AiJD THEREhFTER IS TO � <br /> � 3200 Cedar Sireet BE DILIGENiLY PURSUED TC CUMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELIED BY THE CIT`!UFON ANY STO?PAGE OF bVqRK ON THIS <br /> Phone: 259-8815 PROJECT OVER 50 DAYS DUf7ATION. <br /> r <br />