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Date�S��'-�.5 PuEfc WaIXa Permit s � �( � <br /> ApFlication For eia9.oeo��• . <br /> PUE3LIC WORKS PERMIT ��3� P°°°°W°.k°F°a — <br /> � Totel Fex s <br /> Less Appl Fee PaiE s ` <br /> Balanca Oue s �✓' �� <br /> Print or'fype Only . <br /> ,� r,�T T t c <br /> � 111J= LZ Fl C�1/'1�.NJ T/ �,�1 /�j m�Y.GA�/2 ���F_ N1 �✓A � 8 3 / D.S a <br /> Owner Mei6ag Acldress City Zip '1 J O `/ Phone <br /> L-/Z�AN.7i_ <br /> S-lf GiiZL-tRF1tI� laYi� 171T11!to6F �� Yv, r»L�.S t.il� �13'ai� �qI -G8y7 <br /> Applicaot hlailing Address City Zip Phone <br /> Describe Proposed Work _ C. G �f-1 R ��O (� D /- �ll U S �J d' .5 M.hl Z L / IQ� r,s <br /> L c7TS `/`/ �'�T_��� 7 oF C � B ro a.1,�.. cf.st- W <br /> Project Address�if known) � b ) + � O .1 3. � M E/� l�/ - = T � <br /> Attach four(4)copies of ptens for proposed Hork• Draw to scale and note the lollowing as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outiine and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show me2surements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERIAIT CONDITIONS <br /> 1. All cal�s for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All worrt shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Locatior Underground Service48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �i:.; �e;e:j,.�' �S ��.e' GGE.a.C'i.r/G c��rl�s/ NO G,f'4Di�r/l O <br /> d f Lo�- c-��u .3E" A�c dcvE,�. <br /> S STi�ET - SioF �iTC.l� l�%GL /3E �c`'EVT CCEa.<' � <br /> CJF !�'/�:t'iS, �I/ <br /> �,, .U'O /.c.�O.E'.0 GrJiLG dE t�-''J.(/E 7.s%�T Ld/GC I�n/�dC% <br /> TfiE .��.�v c�a;�:e �PLNOF� UFf �f A•yo o^��o QOJacE�✓f�o7_�': O <br /> 7 r�,�cTiYCOS Gy� �,e"oSi�ti" Neio Sc��i�n£,e'Ti�•rioN Coiur.evG � <br /> � (���Lc dE DE�F•Cin�iv�� af'� iifE i�i�iy�iG CcJO.t'/.S� I�+/�/�E�c.e <br /> �f ,vE�c ssa.e�y; vv,F„vU <br /> � /.r/��i:C u/iic 6F ACco�.,i��,s�FU �ti' �O i>� s <br /> J (y��/� (.�JE�I.•�C� AND .S�TE S's/c ci dE S AC�O�DGEM N�OF CONDITIONS <br /> G�QSS GUy�d c.GE:4,C.ti�v iS c�r�i�lE TE��, <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City ol Everett Irom any and all claims for dama�es, costs, <br /> " - expenses, or causes ol aclion that may arise becauee of installation <br /> � � �. %� ��-7 ��C_ and maintenance of the improvement or other right�obway use herelo <br /> __ � � applied for and further agrees to remove same upon notice irom the <br /> Approve, or Co trli tio Date City and to replace public proporty Aamagetl thereby. <br /> i _� <br /> 1��Po(� �, � <br /> FINAL I ECTI N Date <br /> Appruv�:d as Consiructed Signature of Appli a t Date <br /> everett PUBLIC N'ORKS DEPARTMENT WORK AUTHORIZ D BY THIS R IT MUST BE STARTED WI71�I�N <br /> 780 DAYS OF DATE PEFMII' IS ISSUED AND THEREAFTEA IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PEHMIT MAY BE <br /> Everet7,WA 98201 C�.NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br /> Phone: 259-8875 PROJECT OVER 90 DAYS DURATION. <br />