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Date�(� I�[�� ' / PubLc\VorMs Permit� �—^�v <br /> L� <br /> Application For Bltlg Dopi.� <br /> PUBLIC WORKS PERMIT PubTotvFooFpo $ _ ' <br /> Less ADP�Fee PaiC S <br /> Print or Type Only s��o��oo�o a 38�— <br /> �1����, /�1��I L�-Ji�7 ,��r�trl�y�/�� ��d7—�'Z✓� <br /> Owner Maii ng Address City 2ip Phone <br /> �//[� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work / /C�GCJ J!�/� LCT�'�� /�/���� �/�,�/ ��� 7 <br /> �sY l� <br /> ProlectAddress�ifknown� ��— � /� /CL G�— �p7— (p � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as app!icable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT'!T,ITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t All ca�ls for inspection shall be mau�. �� hra in advance• phone 259•8815. � <br /> 2. All work shall be performetl In ar,cor la��.ce with this psrmit and current City of Everett Design and Construction <br /> Standards and Specilicati ms. <br /> 3. Call Location UndergrounJ Sr�vJ.,�4._ .�rs,belore you dig.TOLL FREE NUMBER 1•800•424-5555. `'`� <br /> s� ,vo c��,�,�,,��:- ;�: eE ��,ti-f" LcJiTHii✓ as ' o�' T�r� � <br /> c$'i.c'EF.i» C'n.�:r'iUD.t'_ O <br /> � /�.�o✓ivr f�� NEffS.�1.�'j� .�i�OSiO.t/ � � -�..; <br /> _ y� , C�:,��� �s• . <br /> .D;e.Ec,-c 0 6'y T�� ,�dc,c cdo,��,rs .T,ds�<<,-o,a . � � '� <br /> /. �, i�'I<<ricG ,9ur'. �SY1.9ac: �?r' /��'liED c�ir�! iS'SPN-9cT %=c(.C' �I/ '� <br /> CiTf/ cST.�.c/t7.4�,p � .92l,a. Pi�Ui•r/G- CJo,c�,c' ja /rl9T'f! � � <br /> Ci'.9DE �' GJ7DT.y of e=,�v cfi- �x�sr�.�v- �s:��9�T �9r .Pnh'vt�!'f/ � <br /> CUL�'Ci�T., I•�Jsr9[[ viTcr/ ,gLo.vG SouTif S oF o�' i?J�cY��� <br /> �.ccvCti r <br /> TpJ��',,i✓ uJ9TE.�.� �i�,c�PtJ'' O.✓'Tc� LGj,s O.t �,PvI�iDE .�Si�//%!?" <br /> �� /JS /�i.E'rC7E.A .t�f/ C/� IN��'Ta� . <br /> �CKNOWLEDGEMENT l�F CONUITIONS <br /> The undeisigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Evereri Irom any and all c'aims lor damages, costs, <br /> ���-� expenses, cr causes of action that may arise because of installation <br /> ���j`y, � c�, and maintenance of ihe impwvement or other right-ol-way use hereto <br /> � applieC for and further agrees to remove same upon nolice from the <br /> Anproved lor Con uction Dale Ciry a d lo replace public properry dam�ged lhereby. <br /> ��� Z�Z��V / �` � /l . <br /> FINALINSPECTION Date � •��-i �j � '��n`�"l�� � ,� S�/ � .' <br /> Approved as Constructed Signature of Applicant ' . �Date <br /> everMt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS Of- DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED L�1'THE CITY UPON ANY STOPPAGE OF Wi,qK ON THIS <br /> PROJECT OVER 80 DAYS DURATION. <br />