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, �B�Ek�L��� GuOiw Worw�Permit• 8•J�� <br /> Appiication For eiao.oso�.+R� � � 7� _ <br /> PUBLIC WORKS PERMIT PuEticWorkeFee <br /> Tolal Fee : <br /> Leea ADGI Feo P�iE S <br /> Pfini Of Type Only e.�s��a o�, • zO O� <br /> 7s3�9' <br /> /.�� ,,.C'� /��iT i/� � � ..�_ � ri 5��. - �s� ��ct <br /> OWner / Mailing Address � City Zip Phone <br /> 5.:. Ti...� �;...+< S� <br /> Applicant Mailing Address City Zip Phone <br /> � <br /> Describe Proposed Work -�:•� l �m:�_ /�� <br /> ProjectAddress�ifknown) f�/S � — � '�r .d�P, S' 6, � <br /> Attach four(4)copios of plens for proposed work- Draw to scale and note the following as applica6�e: � <br /> • Properry Lines • Centedinn of sireet � <br /> • Outline and dimensions ol all existing and • Indicale North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measuremems � � <br /> DO NOT WRITE BELOW 1Ii15 LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs in advance•phone 259•887 5. � <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everett Design and Consfruclion <br /> Standards and Specilications. <br /> 3. Call location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> /�, T�/�S c4Git��,(i� Fo,e t�S6 ifs st f��cDEc yo�.E' O <br /> Q�/�{/, it/OT Tp BcE OLC!/P/E O �/?/TiL Fi.Y�G G <br /> / <br /> /�l.d T /4�'/�!'�l dd G . � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT.�F CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> ��� LiJ,2�'}/ �;Cd.t/`o.C� less Ihe City ol Everett Irom any and all claims lor damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> C-a,�!�•�/ •7 / 2 ����85 and maintenance of the improvement or other right-obway use hereto <br /> �X�l/li /��Orfy� � applietl for and lurther agrees to remove same upon nolice Irom Ihe <br /> Approved lor C � struclion� Date City and lo repl�c prop ty damaged thereby. <br /> FINAL INS ECTION � �I V Date a' —� s�� <br /> Approved as Construct Signature of Applicant Date <br /> everett PUBL�C WURKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIP! <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 9@201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />