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87- zZ7 <br /> Date�L'L �/� Pu�lit Works Pcrmil s <br /> eiaa�oea�.� <br /> Application Fcr <br /> PUBLIC WORKS PERMIT PubTolaFeeFea $ <br /> Less ApP�Fee Paid $ p <br /> Baianco Oue $ �u� <br /> Print or Type Only <br /> �►-���� �r� lq i� Yv ��td' #�o-� �r�r�r� a�D 3 ����i� <br /> Owner Mailing Address City Zip Phone <br /> ��ant Mailing Ad��ress Ciry Zip Phone <br /> Describe Proposed Work ��1 � �� ��� L�� 7 �OC/C 7 b��✓1 <br /> �V1 P/' C� .. <br /> W :'� <br /> Proiect Address(if known) — � �n G/LC E � <br /> Attach four(4) copies of plans lor proposed work- Draw to scale and note the following as applicable: � ,���'� <br /> • Property Lines . • Centerline of street � i�� <br /> � Oulline and dimensions of all ezistin9 and • indicate North � <br /> proposed struclures on the Iot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M : <br /> W ;� <br /> DO NOT WRITE BELOW THIS LINE O � j;�� <br /> PERMIT CONDITIONS �"�i'� <br /> 1, All calls for inspr.ction shail be made 24 hrs. in advance• phone 259-881 5. � .',1� <br /> 2. All work shall be performed in accordance wilh this permit and current City of Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 h�s.belore you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> � /1�D C�EA.�i•r/G Tc� dE Da,�IE uJiT./i.r/ �S � p�' 7NE O <br /> si.PE9�n CU2�C'iA�^.�'. <br /> ,S /�i2o✓/OE S'-uf/ �_FCESSA,.-_f/ E.�'oS.o-tl �'n.VT.2oL AS j�/.PECTFo � �:-� <br /> ,�j� jhL� PG•dL�G LrJO.E'.KS INS�ECTo.�, � <br /> (n. E. !�'lCbiLL A[¢ Sil!9G!- BE /�f/v.ED L<liT!/ AS�GT �G�"/L c:'/7f/ O <br /> ST.9n/D��O �3��, /�Jr��•r/G Lc/a�('�t" To �nqTcr/ 6f,AVE �" �c�iD:r1 <br /> OF E•c'/S TiNb .9SPIY.FfL i !�T �O.P/�1<if.�� �UG✓E2 T, 1A/Si.9L L � <br /> oF EN�7 oF ir��G�Lc To P.���v.�.✓� ��9�•✓«�'rEe <br /> DiTC/� A�a.�-,G Soar.� SiDE <br /> ���NOf� aNTo L�i'r �' ��U1ii,pE ASs'!/A�T L//� AS .t�/.PE�TFA <br /> ay c,Ty <-Ns�F�>�.�. <br /> ACKNOWLEDGEMENT OF CONDITiONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> _ less the Ciry ot Everett from any and all claims lor damages, costs, <br /> exoenses, or causes of action that may arise because of installation <br /> _ ,p `� � � g j and maintenance of the improvement ur other righhof•way use hereto <br /> �YJ'?[r�--s applied for and further agrees to remove same upon notice irom the <br /> Approved lor Con t uction �a�° y and to replace public property damaged thereby. <br /> (�- - zl - �.�` ���� �t(a���>�� >����-� <br /> FINAL INSPECTION Date ' Date <br /> Approved as Constructed Signature of Applicant � <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DA`f5 OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED RY 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-�815 PROJECT OVER 90 DAYS DURATION. <br />