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Date_'JC/^� / � PubbC WOds Permil� �-j(CSEL_ . <br /> / <br /> Application For B�o� Dea�.• __ <br /> PUBLIC WVORKS PERMiT P�����=�v�,�=F« S --- <br /> To1alFpe __ <br /> Less<ot>I Fee Pa�� 5 �f'� <br /> ' Baiance Duc S�_ <br /> Print or Type Only <br /> ,J ,1; <br /> �;, <br /> �5��,� �E����l �/t�.3 �=• mA�ci�v� ✓`t 2�v= E= g c� <br /> Ownei \ladincACdre55 ` ;' : ,.C+i)' 7_ip hone,��� _L_/� <br /> r r.� �� . CT �Y�I�f <br /> � I/i r�l . - , <br /> Applicant h?ail�nq Address City Zip Phone <br /> Describe Proposed Work � �� L��_�/� C�____F��___ ' <br /> _ �R� I�{ c/L __�_1�2� �''6�_—�2P�.C-�6�1LGYe�.�L�_ <br /> Project Address pl knowN ���^^--�—.— ___ _ � <br /> Attaeh tour 14)copies ot plans foi Uroposed wurk � Drav: to scaL� an,y nnte �he toiluwing as apV�icabie: � <br /> • Property Lines • Cr.nte�line of street � <br /> • Outline and dimensions of all existing anA • Indicate North <br /> proposed s�ruclures on Uie Io1 • Shew any proDosecl c�rading changes <br /> • Existina and proposed utilities • Show measurements � <br /> DO NOT WRITE B[LOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AI'calls for inspection shall be made 2A hrs.in advance•phone 259•8810. � <br /> 2.All .vork shall be performed in accordance with this permit and current City of Everett Design and Construclion <br /> Standards and Specitications. <br /> . 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 4, �.111XiM�,wt �FeNCe. I�C;c�Nt itit -�iC �^��h� -o{� -wa�. ✓1°�. O <br /> � �XCt'_l.'�u � Z �, ��.Z�� M QX i�l �h-(- `rar�l set I�;cIC ��, <br /> / L <br /> cj , LC2.� �cce�s � w2,-�,' m eEeti' (sl,�.E. o�'E box�, r' <br /> � <br /> 0 <br /> a <br /> ,/Q� ACKNOWLEDGEMENT OF CONDITIONS <br /> ���d The undersinned o�sner/apphcant herrUy agrees to hold and save narm� <br /> �—�---� less Ihe Gty ol Everett trom any ¢�+d �,'I claims for damages. r.osts. <br /> C��'� � �/�//� i exUenses or causes ol action Ihat n�ey arise betause ot installation <br /> C �' � and rnaintenance of lhe improvement or other nght-ol-way use hereto <br /> appl�r,C lor and lurther ag�ce� lo remove same upor notice Irom the <br /> Approved for C nstruaion.- �� Date I Cdv and to replace Vublic pronerty damaged thereby. <br /> %c-�!- �- Z Z- h � / ,/ /} � <br /> FI AL SPECTION Date i - ��/_g f -�f-l/L � � 7-5 <br /> Approved as Conslructed S�qnalure of ApPliCant ate <br /> PUBLIC WORKSDEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ���� 3200CedarStreet �90 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> FqO.�ECT OVER 90 DAYS DURATION. <br />