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; --- / <br /> Date 3- 5'-`/`� ;: �2 - <br /> - P�el¢worh�pe.mil• <br /> Applic�gtion For eiay.oeo�.• <br /> PUBLIC WO�KS PERMIT P��,��Wo�k=F�e <br /> � To1al Fee = <br /> Leiv AppL Fee PaiC S <br /> Print or Type Only � g g a,�,�«o�� s�S°—o <br /> a _ <br /> o � � ULJ2 - <br /> � -3z Z'fo i/8�/ <br /> � N <br /> �������, � Cl�� �- ,L�k� ��l w<z ��as� <br /> Owner �Fa�, dr�s CitY Zi <br /> P Phone <br /> c � c� y�6-f <br /> ApD��cant Mailing AdAress City Zip Phone <br /> Describe Propo/sed Work / � �v � � jr 4 � - i 'Gi � �• ,� ��t_' �,('C � ��S <br /> — �i(�r i`ll �1 � CI ��,� G-, r .�-��� P �'••I t � _CT t,S O .� GC./Cc� . <br /> G -� /� � o � /'�vi �wc WtV C.0{- �G l�u�� <br /> 7�— <br /> P`tiv `r,t� �1'.., �3�' ���,b �c a ,,.e a�.,, -�-; � <br /> Project Address(if known) _ � / �� / Q.Q � � lC, �,,� L�;�„t {- � J y , � <br /> Attach four(q)copies of plans for proposed work• Draw to scale and note the following as applicable: <br /> • Property Lines � <br /> • Centerline ol sVeet � <br /> • Outline and dimensions of all existing and • Indicale North <br /> pr�posed structures on the lot • Show any Froposee graaing changes <br /> • Existing and proposed utilities � Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All cells for inspection shall be mede 24 hre.in advance•phone 2$�-8�1 Q, <br /> , 2.All work ahall be peAormed in accordanca with thia permit and wrrent Cit}•�,'Everett Design and Construction ' <br /> Stendardaand SpedHcatlons. � <br /> 3.Call Location Underpround Service 4B hrs.before you dig.TOLL FlIEE NUMSER 1•800�42�-5555. <br /> � GzJvr,E � / �' <br /> t�o ./� �bne Pe/' 4�Pro�/r,c� vLon O <br /> A����d 3���.��� , �'ca,�y ���u���d) <br /> c� �Grn.dc. for / � <br /> S, J�UPG l'�4/r�lci�E�C r �O /"'/�n TO �q nc�Sc a��n� � <br /> �,�rjGrc E'l/CY POSfiI�Ce _ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF C(�NDITIONS <br /> The undersicned owner/applicant hereby aarees to hold and save ha�m- <br /> less the City of Everett lram any and all claims for damages, costs, <br /> � �: <br /> ezpenses, or causes of aciion that may ari,e because of installation <br /> �--- — _ �' `.� � and maintenance of the imorovement or other right-ol-way use hereto <br /> A roved Co Itru ' n afe applied for and further ag�ees to remove same upon notice from the <br /> / Cily anri to replace public�y amaged thereby. <br /> � �'/F- 5' —__� <br /> , <br /> FINAL INSPECTION a1e � <br /> Approved as Construcied Si ure of Applicant <br /> ____1� <br /> �e1B <br /> PUBLIC WORKS DEPARTMENT �NORK AUTHORIZE� BY THIS PERMIT MUST BF STARTED WITHIN <br /> 3200CederStreet 780 DAYS OF DATI_ PEqM1T IS ISSUED AND THEREAFTER IS TO <br /> Everett,Wq gq201 BE DILIGENT�Y Pl.RSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259-8070 CANCELLED BY THE CI7V UPON AN1'STOPPAGE OF WORK ON THIS <br /> PROJECT OVER f0 DAYS DURATION. <br />