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i' <br /> � <br /> ( J 325� � <br /> Date_.Se�� Jeh� �T� / dS�l �9 PublicWoikaPerm�l� <br /> Applicalion Fpr <br /> S/3a/q� Biap oeo�.• <br /> � PUBLIC WORI�� PERMIT PueTolaFeaFee s — <br /> r� Loss Aoo�.Fae PniE $ <br /> o �QoO <br /> �� BalancaUue $ <br /> c' `r' — <br /> Print or Type Only F '' ' ' <br /> « <br /> p r� r_� <br /> rl ' I (1 <br /> i �P <br /> CI� <br /> }: c �'y1-7�7 S I�/Z.L �'/S �Y�.E7Yl��n� l��r r=�'L-�ZC��1 I.✓r4 .Ifll� � � S�? �- Z� L '� <br /> Owner Mailing4ldtlr � . Cily Zip Phone <br /> � � :� <br /> �.� Q . c.i <br /> [1 C7 r W <br /> O i� T � <br /> ���i��Nr C'c ,vSjti , . �c <'� iwc l,��„°i- �c753. t.- LyuK�,:.. yF��1c 778- � )- �� <br /> Applicant Mailing Address City Lp Phone <br /> Describe Proposed Wark �"—E°'�°'r� ��al'^o�s�`��v � � ��b��/�� ���J <br /> , df�PcOrS-C. 07 �02d�� <br /> p�ocu�,.�mr�r .�' �� -t-.,.2'`_ C2�cL 6'a� � <br /> WI <br /> Prolect Addresalit known) 3 / i 1 ��� <7u jc,v 1�L, L1���1 � �� L.-',-7 )� ;�y - � � <br /> Attar.h lour(4)copies of plans lor proposed work-D�aw to scale and note ihe following as applicable: � I, <br /> • Property Lines • Centedine ol street � I <br /> • Outline and dimensions ol ail exis�ing and • Indicate Norih <br /> proposed struclures on the iot • Show any proposed grading changes ' <br /> • Existing and proposed utilit�as • Show measurements M <br /> W <br /> DO NOT WRITE BEIOW THIS LINE � ' <br /> PERMIT CONDIT�ONS <br /> 7.All calls for inspectton shall be made 24 hrs.in advance-phone 259•8810. � �, <br /> 2.All work shall be perlormed in accordance with this permit and current City ol Everett Dosign and Construction <br /> Standards and Specifications. <br /> 3.Call Location ilnderground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � CG.� 4v�i a2f c�.� c�/'r c•2Krn/.•/y n n d P ofc.Li O <br /> S �1Gry r��Pe h��ni�Uin OT � 77� <br /> �o. Griv�Xfi�1 CXCG�.zOu7' O�� �inG' Lc1G�ST O� vriv�c,ln�/, H <br /> / _/ <br /> O <br /> � <br /> I <br /> , � ACKNOWLEDGEMENT OF CONDITIONS <br /> l�\� The undersigned ownedapplicanl hereby agrees to hold and save harm- <br /> less the City ol Everett Irom any and all claims for damages, cosis, <br /> , /�� expenses, or causes of action Ihat may arise because ol installation <br /> � fL 2� and maintenance of Ihe improvement or other righ4ol�wa�� use hereio <br /> applied br and lurther agrees �o remove same upon notice irom the <br /> Approved f - nslrue io� Datc Ciry and to reUlace public properry damaged Iheieby. <br /> �/ G n/ �-� �-' �'����, �.� ��:�.J. J 3, /ij� <br /> FINAL I PECTION ate .1�.—�- � ' � <br /> Approved as Conslruc�ed Siynalure of Appliwnt �: Date <br /> � WORK .4UTHORIZEb 3Y TI11S PEf7M1T MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT �gp DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ,��� 3200 Cetlar Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:e59�Fi8t0 PROJECT OVER 90 DAYS DUHATION. <br />