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� .:i`o�; .. . -F-f. <br /> Date_Sa�v ` PuElmWorhsPcrmn. �8" O <br /> r <br /> Application For emc.oec�.• <br /> PUBLIC ��IORKS PERMIT PubTotalFeeFee S <br /> Less Rppt Fee Paid $�_ <br /> P;Iflt of TypB Oflly Balance Due 5 �y✓��� <br /> I )u , +pa�..�=1eE��c �craa/�� ���o 1���(`f- ��zo� 339-536,6 <br /> —�O�wner Myai��,dress City Zip Phone <br /> Sfl ��A �AP �Jj�O�� <br /> Applicant Mailir�g Address City Zip phone <br /> Describe Proposed Work _��(�'/�� ___��'L_�"11���—C�((/��-+(/�� <br /> Project Address(if known) ,7�����Q'�^p � � <br /> � <br /> Fttach four(4)copies of plans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of s�reet � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> proposed struc�ures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All wcrk shall be peMormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBEH 1•800•424•5555. � <br /> s! ��;���o��o �e ��,Le�z� �j,�� O <br /> � Q/�O �a�-8e , C����c%� � <br /> .� 4���,co �' �i�ov,c��/�"-4 oa�..� (� <br /> qv2i�.-� �v cZ�� ��' O <br /> ,/ �/ � <br /> rf PB� �MRHLL 9uRnt. n� �. s � �3 r�� yl�e0� <br /> UN "� aV �� I7�� ACKNOWLEDGEMENTOFCONDITIONS <br /> J <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — less ihe City ol Everetl Irom any and all claims for damages. costs. <br /> expenses. or causes of action lhat may arise because of installation <br /> �p anA maintenance of the improvement or olher rigM-ot-way use hereto <br /> /0 � 08 applied lor and turther agrees to remov^_ same upon notice irom Ihe <br /> Ap ved or nstr o � / Date City and to replace public properry damaged thereby. <br /> _/i��� � ,� 1 F�' _ �f � ,�1 t/' �// <br /> FINAL INSPECTION Date `�/� �IILf/ h/-F.� �%7�� <br /> Approved as Cons�ructed ature ol Applicant �—��— <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarCireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 8E DILIGENiLY PURSUED TO COMPLETIO.'J. THIS PERMIT MAY BE <br /> Phone:253 8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />