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Date��� P��„�Worka Permil• ''/�5, . . : ^ <br /> —r 4 <br /> AppllcatiOn Fo� BIOp.Dect r S �' � 1 . . <br /> PUBLIC WORKS PERMIT PUEIICWorkaFee <br /> Total Fee `S <br /> I.ess r1pP�Fee PeiE s <br /> ea�aorooux S '�Q�� <br /> Print or Type Only -- <br /> �(.l'�'1� CoP-P• PD• 6o K 12�'L �e�►1�Ew �18oi v q47 DgGo <br /> r Owner Mailing Address City Zip Phone <br /> t. _ .. <br />� I <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work u�UJ WN�J�Gi l mN ' Sl N�! �"�' — C�kM1I<<—Y <br /> s���� W <br /> Pro�ect Address QI known) '�'l�'�— �'�VG�nv�t/T � <br /> Atlacli four(4)copies of pl;:ns for proposed work- Draw to scale and note the iollowing as applicahle: � <br /> � P�operty Lines • Center�ine of street � <br /> • Outline and din�ensions ot a�l existiny and � Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existi�g and proposed utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made?4 hrs. in 2dvance- phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Stendards and Specificatlons <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �! � Cc�.c!.fr.c�c:�CT �9 �•���urE n.0 <br /> , AP.��icd.ti�T /LJGST I'I'1d.t.NoGE O <br /> T <br /> �,e'/GGTE P-�cvF,ef/ i.s�E.c� LA3/ A b,edr/�ry SiDE <br /> SE�/rJE.e TU %/!E SECIE.C' /YId�IC�. (/��7i�L/Cdii/T <br /> /�4S /1'/d.OE F.sc v /Yl�aSu.e6MENSS Tn OE7E.FIr�i.uE � <br /> T.�YdT SioE �<<v_�c' Cc�v�'� G�-a ✓-•-1r �.vTo /rsGi�c/ N <br /> F>��i�, P,Poo�',Pr� C..vE-� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ow�er/applicant hereby agrees to hold and save herm- <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> /i� ��—�-f J//�J expenses, or causes of acP n that may arise b�cause o�Installation <br /> �'"�<� „ and maintenance ol the im rovement or other ri ht-o(-we use hereto <br /> � Y �j� appiied for and further agrees to remove same upon notice fwm the <br /> Approvetl for Coristruction Date City to r place Fublic property damaged ihereby. <br /> �--.��-G i�-�� ..� <br /> I. INSPECTION Date � <br /> Approved as Constructed Signature f licant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,\NA 98201 BE DIL�GENTLY PURSUEG TO COMPLETION.THIS PERMIT MA�Y BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br /> PNOJECT OVER 90 DAYS DURATION. <br />