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/'�� •-�� / i � ,4l� ! � <br /> Date�G,�� PUEiic Wa�ka Permil• � <br /> / � Bio.� Dept• <br /> Appfcation For <br /> ��li3LIC WOFiKS P�RMIT P°°��°�°°�k°F°a <br /> . Talal Fee s <br /> Le�s RpO�Fee PeiC S <br /> Balence Dov $ ��' ���� <br /> Print or Type Only <br /> 7SP7� <br /> P/�/I[.�fP W. J.,-,iT//I�.,J /SdS' G�R„� l-VE�•ETr !a-Zol �'2-i�� P <br /> Owner Mailing A� Jress City Zip Phene <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work . �-C � ��-� � E f�.��C, L � �An, i�y /'�-�.r/,� E�ie.E <br /> � <br /> aivTo %NlS� S/ I E <br /> �z „� � <br /> Prolect Addr=Ss(if known) �l-�-1 �����`� ��p � �� °�7� � <br /> Attach tour(4)copies ol plao.+for proposed work- Draw lo scale.�nd note the lollowing as applicable: � <br /> • Properry Lines � Cenlerline ol street ♦A <br /> e Outline and dimensions ol all existing and • Indicale Norih V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed ulilities ! Show measurements � <br /> DO NOT WRITE BEI.OW TIiIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspec�icn shall be made 24 hrs. in advance- plione 259•881 5. ^ <br /> 2. All work shall be perlormed in accordance wi�h ihis permit 3nd current City ol Everett Desi9n and Construction ♦ <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> y. .4�j�,ca�,: i,-�:s T ,�,or.�- s���T,� r-Ek�„�,T �•�,,., O <br /> L �'c,.vTv b'EFo.C'� ,- <br /> / �c. Ci7/ r� ' E �.':�.�'r/% ��C.c�/iJi%S L <br /> L�I/% Gc'r JS.Sc'� �. r <br /> � v� <br /> . 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> .he undersigned owner/applicant hereby agrees to hold and 52ve harm• <br /> � less the City ol Everett �rom any �nd all claims lor damages, costs, <br /> expenses, or causes d action inat may arise because ol inslallation <br /> ���(�� � /J ' //� . I and maintenance of ih�: improvement or other ric�hFol-way use herelo <br /> `�J� � <>Z'sf-%+� J/� -� applied lor and `urthe: agrees to remove same upon nolice from the <br /> Approved for Const �cl;� �a�e City and to replace p�blic property damaged ihereby. <br /> ' I <br /> FINAL INSPECTI ��3�a� _�� it�f���LM � _���,/-�1kS <br /> Approved as Consiructed Signa�ure ol Applicant � Date <br /> everetl PUBLIC WORKS DE'ARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 7P0 DAYS OF �ATE PERMIT IS ISSUED AND TH[REAFTEf7 IS TO <br /> � 3200 Cedar Sirert f? DILIGENTLV PURSUED TO CO�dPLETION. THIS ?ERMIT MAY BE <br /> EveretL WA 98}n' I, �„i��:';ELL[D �Y iHE CIT1� UPU�:ANY STOPPAGE OF WORK ON THIS <br /> � PhOnC'. 2F9�BH15 ' �ROJ�r:T OVE'' 00 Dl1YS DU;iATlO.^I. <br />