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Date��� P���,�wo,.s Pe,m„. /� Z/� <br /> Application For eiao oeo� • <br /> PUBLIC WORKS PERAIIIT - 9i iL�- <br /> v�ei�c wo.ks Fe7-- <br /> rmai�ea S <br /> Leas�oo�Fee vaa S <br /> Print or Type Only BaianceDue S���O <br /> 00 Z-.3ZZ-`fo -Oo0-�/-S 3/ <br /> �1�q���ti/,� p0 !�C �/! L�vP/P� 9,�Z�Y� Z�SZ - 75// <br /> wner � Mai ng Address City Zip Phone <br /> U�,� ,,,,� _ <br /> Applicant Madmg Address Cdy Lp Phone <br /> Descnbe Proposed Work �p Nl � /f`�"� �(',2�0✓�.���/,�� <br /> _ . � �^ � <br /> Project AdOress(if known) S / •� � . <br /> H00026976 <br /> Attach four(4)copies of plans lor proposed work• Drew to scale and note the following as appiicable: ELDu 8�87.3D � � <br /> • Property Lines • Centerline of street E SR�H :;.`0 ♦A <br /> • Outiine and dirmensions of all ezisting and • Indicate Norih pWTN S^ 5.'_,S.OtI ��� <br /> proDosed structures on the lot • Show any proposad gradirtti'C� �iges <br /> /1 Existing and proposed utilities • Sh,ow measuremeMs �F��G� 8525.30 � <br /> DO NOT WHITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t.All calls for inspedion shall be made 24 hrs.in advance•phone 259-5810. � <br /> 2.All work shell be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hre.before you dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> / • ���C�O�f,�, /l2m�rzv /Y�le_e� '�io� � Cmt.�u���a�y O <br /> C�Oy4-Z _�C� �y / -�cryvt � CjnzZ��v-;�ui o� !'Qi�r�-��� <br /> (/ y � <br /> %a �_l(tu� �Cn+ .�.�z�.' rm,,J-fi«.�cl�� � St�v�.�,n�inv-+'�w',,,C� <br /> ��� I I �� L � <br /> v�/�.� l� � <br /> a <br /> �-��,,� ���i � z <br /> b'1,�.S I�1 lj �v OF CONDITIONS <br /> The� by agrees to hold antl save harm- <br /> less ���e �N� G �1�i all claims lor damages, cosis. <br /> 2%Pe� � �ay a�ise because of installation <br /> �`�� S— and r AA or other rlght-o�-way use hereto <br /> ApprovedforCons� ction '�� app�° �Av����AI �� �ove same upon notice Irom the <br /> ate Ci� ���� maged thereby. <br /> +r+��z <br /> FINALINSPECTION Date (� ,�f1.��� /Jr.;��� '.� ���" � �-��1� <br /> Approvetl as Constructed Sgnature ol Applicant � Date <br /> �A�`'R= PUBLICWORKSDEPAflTMENT WORK AUTHORI2ED 8Y THIS PERMIT MUST BE STAR?ED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA g8201 BE DILIGENiLY PURSUED TO COMPLETiON. THIS PERMIT MAY BE <br /> Phone:259-8810 GANCELLED BY TNE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />