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Date � �20��`�" q�/ ^ / <br /> � P�obc Wor��perm�t. / 7' �J CA/ <br /> Application For e�eo.oeo�.• <br /> ' PUBLiC WORKS PERMIT P�o�KW��k�F« <br /> ,o�.�F« : <br /> Let!AOGL Fee Paid S <br /> Print or Type O�ly BalenreDue s— --� <br /> RW i pE(�tc� 1-�CY'/PI,�tl. � �(i �kci GtL l'1�fi�luE P��A�. ccu�r. <br /> Owner , �v� �� 25`�-74'I� <br /> Mailing Address City ZIp Phone <br /> NEWI.At�lp CG�A�S"r�UGT�ON CD I �lC . �U PAX °lSP� ��1��►-TT `(f�'(�'� 2'"-�I-�IG l <br /> Apphcant Mailing Address City � Zip P�one <br /> Describe�roposed Work �hLc � �-�,�iV� — N��fj�U ST. F3�T�,,� J,� ��j7 Na <br /> 33�D pr.f F�S. 13�� F1zo►� �:c�o AM <br /> �Tn f0 Gb ,4ll.l lt*�a A6A.1�` <br /> ON EiTl+e� . . • �R uNDA <br /> �a. zn*��.� �:oc� �w -,-� �v:�A — v� �c�� -roN c � at� W <br /> Project Address�i�knowr� � �� �C 1 FiC.� ��}.IUG— p �� -�L }.�y.� ��L � <br /> Atfach four(4)copies of plans fur proposed work- Draw to scale and note the following a;applicabie: <br /> • Property Lines � <br /> • Cenlerline ot street � <br /> • Outline and dimensions:d a!I erlsting antl • Intlicate North <br /> proposed shuctures on the lot • Show any proposed graaing changes <br /> • Existing and proposed utilities � Show measurements <br /> DO NOT WRITE BELOW 7HIS L�NE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inapection ahall be made 24 hra.In advance•phone 259�8$10. <br /> 2.All work shell be peAormed In accordance with this permit and curtent City of Everett Design and Constructlon ' <br /> Sftlil�Erdg AOd$p@CifiCBtiOne. <br /> 3.Call Locetion Underprountl Snrvice 48 hre.before you diy.TOLL FI1EE NUMBER 1•800�4Q4•SSbS. <br /> � /(�01`ify fA�iCe' 4.�� y�'rc n%t��fc�i ��i�ff ,s'ri�ecf [.�ilC 6F CIpSEo� � <br /> J Zi�S�< �� .S7`�tf C�o�SPd - C�� ft�l�� / .S'�i7s" a t 6n fh z��Q�J O <br /> O� S�/'C�f cLoSdre . <br /> �G'. F�OSf haficC 2f ��.-,E�,�y on St,-cc7` Gy fhvrs�/ fha t fhe� H <br /> G)nn�t �ic: NSrc✓ on Sun�/,iy �/�e.� lJq�'. �w�/e oI� Gh � <br /> Sn fV�[�i �/ /1�/�f. O <br /> 7. GPP�.��L� Qi-Cr l�.l��on C�0/tC !i/ef�i CI^4ii _ r� Y � ` � <br /> P r S�1=:i � a�("e c�0[J/7 <br /> ._'i. �/��l:tany` !dilL fJc� l�S/�cn�i6lP F�7r �".^��Lrtti.,y �n� /,�)•o/.e /� <br /> Gr ocln,o�c�/ -���-��%f /�n�ro✓cr�en�t �c.•r�ny 7�hiS �UDr�. <br /> ACKNOWLEDGEMEMT OF CONDITIONS <br /> The undersi4ned owner/applicant hereby agrees to hold and save harm- <br /> les5 the City of Everett from an,� and all claims for damages, costs, <br /> I � ^ / expenses, or causes ot action that may arise because ot insta�lation <br /> - � and maintenance o1 ihe improvement or other riy�h;•of•way use hereto <br /> Ap roved r G n tiucF � a�e applied lor and further agrees tu remove same upon notice from ihe <br /> City antl to replace pubfic properry damaged thereby. <br /> � .1�5i.� � � � 1 \ � <br /> FINAL INSPECTIUN Date � rL� �� fy— �—�� <br /> Approved as Constructed igna�re (,!a¢plicant Date <br /> PUBLICWORK,qDEPAqTMENT �✓oA� AUTHORIZED BY THIS PEFMIT MUST BE STARTED WI7111N <br /> 3200CetlerStreet 180 DAVS OF DATE PERMIT IS ISSUED AND 7HEREAFIER I& 7n <br /> Everett,WA g6201 BE DILIGFNTLY P�RSUED TO COMPLETION� THIS PEFMIT MAV 8E <br /> CANCELLEC"Y i HE CI7V JPON ANY STOPPAGE OF WORK bN THIS <br /> Phone:268-BB10 PROJECT OVER 90 DAYS DURA710N. <br />