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;- "l ZG <br /> /,,�,I+,q� Pu�lm Works Pe�mil+ _ <br /> Date�--� U eme oao�.•�_ <br /> �; <br /> Applicalion For . <br /> PUBLIC WORKS PERMIT P"°'"""°'hSFCe S _ <br /> Tolnl f�o <br /> Lass ApP�Fco PaiC $ '/� � — <br /> � Pa::nce0ue $ <br /> i <br /> Print or Type Only <br /> -- ,� 3�1 � H-��`1 4��.�' c3R(03 5�� - F��3 <br /> City p Phone <br /> �']Lx^✓r�Mn I Y� � �'t� /Ll r <br /> pW�ef Mailing Address <br /> 5Yr►� �� Ciry Zip Phone <br /> Applicant Mailing Address <br /> � � <br /> Describe Proposed Work / <br /> W <br /> Proiect Address(if known) �-3 — • �� G/CG v� � <br /> � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Property Lines , • Centerline ol street <br /> • indicate North <br /> • Outline and dimensions ol all existing and � ghow any proposed grading changes <br /> proposed structures on the lot • Show measurements � <br /> • Existing and proposed utilities <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1, All calls for inspection shall be made 24 hrs. in advance- Phone 259•881 5. <br /> 2, .411 work shell be performed in accordance with this permit and current City of Everelt Design and Conslruction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•800•424•555 . <br /> � T.YE O <br /> � ;('C CCE'�9Q•P�•r/e'r i a B�" lxte/E Ge�iTisi•c/ <?5 � <br /> SY'�E.PF� Cd/X%JO�'. . � <br /> 5 E- /77cG�LC �i'oE SNsJL[: BE /�.�'u,E� G�l�r/> �sf'N/�tT P``'�'' N♦ <br /> �/Tr Si`9•���q•C'.!J '#.�26 , P.5'i-.�✓Cr GcJv,c;C 7o m9TC,1! G�'90E. <br /> � EXiSTiai�'s ASP/19CT /I> ���v�JF,�f/ ``' <br /> w�orrf of E.�o �F V <br /> CULYEi�T , a <br /> 9-v 9.PF9 AT �Nd OF E McGicG <br /> G�, /�'�'v✓roEs'f'S'�'y'�<T Ti.c�z.r/.o,cau:�D <br /> O.cl 2"Q�AvE iP�NT-aF-!�/9}/. <br /> � ' <br /> :b ��__-- <br /> I���/ '�`�E��G�j� ACKNOWLEDGEMENTOFCONDITIONS <br /> •'1 The undersigned owner/applicant hereby agrees to hold and save harm- <br /> le�s the CitY of Everett Irom any and all claims tor damages, cocts, <br /> ezpenses, or causes of action that may anse because ol installation <br /> - , � and maiotenance cl the improvement or other right�of•way use hereto <br /> ,� � apf� ed �or and turther agrees lo remove same upon notice from the <br /> Approved for nstr 'on Dale Ci y and to replace uublic proPerty damaged thereby. <br /> � 7r�7�. � , � ��A,�)� ; .fi" . <br /> FINALINSPE ION Date �""'�'� � , ` Date <br /> Signalure ol Applicant <br /> Approved asConstructed yyOFK AUTHORIZED BY 7HIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DII.IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Cverett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8875 PROJECT OV[R 90 DAYS DURATION. <br />