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Date�� c <br /> P�blic N'orks Peimil• ��J���� <br /> f <br /> Application For :7iaQ.�eo�.+� 7�9 <br /> PUBLIC WORlCS PERMIT PuolicWorASFee <br /> Tat�l Fee s <br /> � leasAp.u�FeeP�iE s <br /> Print orType Only B�IenceOue s �C)�C7� <br /> 768'S�6 <br /> �o.v �ACNAOF1'�t.E /v/3/ F��es.- D sE' Ev<r,�-r Sy�� 3S'S=t'� 3� <br /> Owner Mailing Address City Zip Phone � <br /> Fi�src.�.r G��r 235- /6 a �'� S'F /3o i��ca. S`v�2 7yf= µ39� <br /> �7 <br /> Applicant Mailing Address Ciry Zip Phone <br /> Desc�ibe Proposed Work �i+vG�tr- FAw� iQ_Rt <br /> H H <br /> — H �*1 <br /> N � <br /> Project Address(if known) � - � � `y" <br /> Attach four(4)copies of plans tor proponed work- Draw to scale and note the following as applicable: �, o <br /> � Properry Lines • Centerline of street � � <br /> • Outline and dimensions of all existing and • Indicate North � H <br /> proposed structures on the lot � • Show any prcFos=d greding changes z <br /> • Existing and proposed utilities � Show meas�irements � � <br /> � H <br /> DO NOT WRITE BELOW THIS LINE N <br /> PERMITCONDITIONS o ,.�� <br /> 1. All calls for inspection sha�l be made 24 hrs. in advance- phone 259-$81 S. 9 � � � <br /> 2. Ail work shell be performed in accordance with this permit and current City ol Everett Desi n and Construction <br /> Stenderds and Specifications. � <br /> 3. Call Location Underground Service 4b hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> � G,�'�sai,u�• tiii�sr ,�>� l3�a��F-.�tf'/ ��.,�s�tc're-o So O N <br /> A S �o •UaT IInPdGT <iW�aGE�,/�' �vrs I.t/i:'/Y � <br /> I,���,�a� c.v,ar�,e; <br /> s L�c>i✓ST.f'r/CT dE�t� /�C'f/ Lci�LLS F,E G!/i7E� � � <br /> I>Oc.J�1SPU�lTS � <br /> �, `D/JST.�'UCr AS��N,q�T' /�.C'�(/c�cJ.a� `,QD�tq S"T,C'C-'E� O � <br /> To �c,��r of wd y Uu�, a � <br /> 7. ASPrfS4[T PATLy /N ST.¢fET n/ADE /N �nNJu.✓CTiOi✓ W/T.s� � <br /> PREviovs S'EtJE,t Hno�t-v� jp fjF OtiE� LdyED TO TNE , <br /> SiIT/��vcTinN OF TNE• �f'/�BG!c /,Jn�Pf'S -�/��sf'.FCTD�C'; <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> i <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> � /���— ,//`/� expenses. or causes of ac��n that may arise b9cause � installation <br /> 2� antl mainlenance ol ttie im rovement or other ri ht-obwa use hereto <br /> 7 applied lor and further agrees lo remove same upon notice irom the <br /> Approved for nstr ction Oate City and to replace public property dama ed ther y. <br /> S ,,.(/// <br /> FINAL I SPECTI� � I�I,�I� D'ate ���i��Ji�Cr/ ri �0 � <br /> Approved as Constructe Sianature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOFiIZED BY 7HIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br /> PROJECT OVER 90 DAYS DURATION. <br />