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/� �y Ibl <br /> �8t@� ��/(J/k'Y Pu01ic Worke Permil• <br /> \J / / !/ V ! <br /> T '1 3" � <br /> Blao Deo�.• <br /> Applicetion For <br /> PUBLIC 1NORKS PERMI'T P�oGCWorksFea ao.� o <br /> Totel Fee s <br /> Leu�4pL Fee P�iO f <br /> eel�ncs Doe S a'� � O <br /> Print or Type Only . `�y� <br /> t7 <br /> C�C�c..irS �ol� C/�(d - v�ti, cfCQ�� �uPree7� 9c�-ztl '� �3�S--ro13�.. <br /> Owner Meiling Address City 2ip Phone <br /> _�7�1R�ek Goo�le Ca,u� 583.2- 1/9'�'/i)� ��ke ST�P�u �3`/-�>o?G�a <br /> qPP11Ce�� Mxiling Address City Zip Phone <br /> Describa Proposed Work � <br /> - W <br /> Projed Address(if known) ��� � — �`^'d- �v�' � <br /> Attach four(4)copies of plens for proposed work• Draw to scale and note ihe following as applicable: � <br /> • Froperty Lines • Centerline ot sireet ♦� <br /> • Outline end dimensions ol al�existing and • Indicate Norih V� <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Exiating and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITF BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for inspection shall be mede 24 hrs. in advance•phone 259•8815. � <br /> 2. All work shali be performed in accordance with Ihis permit and curreN Cily of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3. Call Locetion U�dergrounC Service 48 hrs. before you dig.TOLL FREE NUMBER 1•g00•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant herr.by agrees to'�old and save harm- <br /> -- less ihe City ol Everett trom any and all claims lor damagos, costs, <br /> �(/"� ezpenses, or causes ot action that may arise because ol installalion <br /> � � ,//� �/( _f�/ antl maintcnance ol �he improvemen� or other right-ol-way use hereto <br /> �al °� applied lor and lurther agrees lo remove same upon notice �rom ihe <br /> -� DAte <br /> Approved for Construction City and to replace public property damaged thereby. <br /> �� �1 I �� ./��_^ ' /�,�/� .J �� ��`� . <br /> FlNAI INSPECTION �a�e f�Y� � <br /> Approved as Construct+d Signa�ure ol Applicanl � Date <br /> WORK AUTHORIZED BY iHIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DAY� OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200 Cedar Stree1 BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAV BE <br /> Everett,WA 982u1 CANCSLLED B`(THE CITY UPON ANY STOPPAGE GF WORK ON THIS <br /> Phone: 259�G815 PROJECT OVER 50 DAYS DURATION. <br />