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� <br />. ? /� 1}� Publ�c Kb�k9 Permil� ��� , <br /> I . �BtE�� BIa9.Deot� <br />��� ' Appllcation For <br />� PIJBLIC WORK� PERMIT PueTollFooFae s <br /> �eaa AOD�Fee Peitl S <br /> Bc�ence Oua $ �D'�� <br /> Print or Type Only 75�� <br /> �h��P,n� �,v3��� /�I�(• yy�' s� �y��{�r �����3 3ss-5y�� <br /> Ownar Mailing Addrrtss City Zip Phone <br /> �Li�/v//' �U/�ST /�/�l� �y�''s�v �'u���,r� ;�'`S'd D 3 3,�r �9`//.,L <br /> Applicant Madmg Address City Zip Phone <br /> z <br /> 0 <br /> NL' ul (�.Ort9 �'�uC}i�� a� S in��l� Fi�.ni lu iP�'S/►�n�F � <br /> Describe Proposed N'ork � <br /> m <br /> W � � <br /> � � <br /> .. .� <br /> � NS <br /> /� - F /Y�A.f/�/�1 GF , "' <br /> Project Address(i(known) c o <br /> � m o <br /> Atlach four(4�copies of plans for proposed work• Draw to scale and note the following as aoplicnble: � � <br /> • Center�ine of streel �� <br /> • Property Lines � -'� <br /> • Outline and dimensions of all existing and • Indicate Norlh r^ <br /> • Show any propo5ed grading c:hanges � Z <br /> proposed structures on Ihe lot = � <br /> • Show measurements � m <br /> � Existing and proposed utilities o � <br /> c <br /> DO NOT WRITE BELOW THIS LINE O � _ <br /> � PERMIT CONDITIONS ^ � N <br /> ♦ � <br /> 7. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. T� <br /> oz <br /> 2, All work sha l l be per forme d i n a c c o r d a n c e w i t h t h i s p e r m i t a n d c u r r e n t C i t y o l E v e r e t t D e s i g n a n d Construction -,� a <br /> Standards and Specifications. � -_+ m <br /> 3. Call Location Underground Service 48 hrs. before You dig.TOLL FREE NUM6ER 1•800-424-5555. m N <br /> 0 <br /> 5j Ijf�a� /v �� CO�(/G,L'E'TF C�/�vE.e.' T A T O c N <br /> tj'Ef�i.r/�viivG— OF l�.c'i�E�dAy, `� <br /> � z � <br /> -i r <br /> m <br /> n <br /> V/ � <br /> -i <br /> x <br /> � p <br /> Z <br /> � <br /> a � <br /> � <br /> Z <br /> 0 <br /> � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/anPlicant hereby agrees to held aod save harm- <br /> . less the City oi Gverett from any and all claims lor damages, costs, <br /> expenses, or causes ol action ihat may arise because ot insta!lation <br /> . �-� �� - �y /J�� 2nd maintenance of the improvement or olher righFol�wap use hereto <br /> �� � G �S applied for and lurther agrees to remove same upon notice from Ihe <br /> Approved lor ConsVuction �a�e Ciry nd to replace ouhlic property damaged thereby. <br /> - / / <br /> � r�/ � ��� �S <br /> FINAL INS ECTION Date � Date <br /> Approved as Constructed Signature of A I� ant <br /> WORK AUTH Z[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere�t PUBLIC WORKS D ARTMENT 1g0 DAYS OF DATE PERPAIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Everetl.WA`.18201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH'" <br /> Phone: 259�6815 I PROJECT OVER 90 DAYS DURATION. <br /> i <br />