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7 <br /> .j � a�/ Pu�licWorkaPermil• �J �/ <br /> Date-�� <br /> Biap.neoi.• <br /> Application For <br /> PUBLIC VVORK� PERMIT PuOToIaIFceFea S <br /> Less.l0a�Fee Paia $ <br /> BelenceUua S "7�' �'� <br /> Print o. Type Only ,5���' <br /> �i?sT•li�tE � irR�c.i� v 23d- /G�Tr, SE fi'o/�iCLL `3d-�i1- �!-s'v-Js..- <br /> Owner Mailing Address Cily Zip Phone <br /> SfA^^/' /�s /S�/1✓.�/.. <br /> Mailin Address City Z:p Phnne � <br /> Applicant 9 <br /> .. <br /> C . � <br /> Descri6e Proposed Work ���✓Ct / �R^ t �Fs� m <br /> .. .. <br /> � T <br /> - � ~ � <br /> N 2 <br /> m <br /> � o <br /> Prolect Address(if known) G� E. /�A.E'i�S�2� ��F c v <br /> m o <br /> c� <br /> Attach four(4)copies of plans lor proposed wo�k• Draw to scale and note the tollowing as applicable: � � � <br /> • Properry Lines • Centerline ol street � ,� Z <br /> • Outline and dimena�.ons ot all existing and i Indiwte North --� <br /> • Show any proposed yrading chr��ges m .-. <br /> proposed structurcrs on the lot .� Z <br /> • Ezisting an�proposed utilities • Show measurements M e <br /> - -- W � _ <br /> �� DO NOT WRITE BELOW iH15 LINE. '-' <br />' PERMITCONDITIONS O O A <br />� 1. All calls lor inspection shall 6e made 24 hrs. in advance- phone 259-881 5. � '*� ? <br /> 2. All�vork shall be perlormed in acwrdance wilh this permit and current City ol Everett Deaign and Construction ,� m <br /> x <br /> Standards and Specifications. <br /> 3. Call Location U�derground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � m en <br /> o r <br /> t� m <br /> O c tn <br /> � A.�/j/ G�(.'4/�/+vG -S/�AL L h'� GUNE SO fl it/OT 7v m `^ <br /> � _ <br /> z � <br /> C,ZENTE �) ��AiN�fGG 1��'Ut7Gt-M %<� AvT�CEi�Y � m <br />� LOTS, H A <br /> � <br /> x <br /> _� 1.�.'tTd[:�C CUGUE.cT /?��E- /F iVr"CE��SSA .t:y, z <br /> O � <br /> x <br /> a � <br /> z <br /> 0 <br /> � <br /> .. <br /> � <br /> m <br />� ACKNOWLEDGEMEN7 OF CONDITIONS <br /> Th�underslgned owner/applicanl heieby agrees to hold and save harm- <br /> less the City ol Everetl Irom any and all claims for damages, cos.s, <br /> i� <br /> expenses, or causes ol action �hal may arise because ol ins�allalion <br /> ��� ,� � ..� ,� and maintenance ot the improvement or olher right•ohway use hereto <br /> .�t /�� �y '� ���' � '� �p�lied for and further agrees lo remove same upon notice Irom the <br /> Approved for Corisiruction Date C��y ano 10 r� ce public properly damaqed thereby. - <br /> � I,N'+� � / <br /> � v <br /> �°`< < �/l�/�2�' 3 �-r <br /> FINAL INSPECT�ON Date � Date <br /> Approved as Constructed S ature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WOHKS DEPARI"MENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED 'f0 COMPLETION.THIS PERMIT MAY BE I <br /> Everelt,WA 98201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> , � <br /> _ - � <br /> ! <br /> v' <br /> J <br />