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l � - <br /> Date'� � Pu�i�c Workx Permil• �7�/J '� <br /> Bleo.Depl• <br /> Application For <br /> PUBLIC WORKS PERMIT PubTolelFeeFee s <br /> Les!.FpO�Fee PaiA $� <br /> Balance0ue S ��� <br /> Print or Type Only �� p <br /> �Cei�l'�U�le�nd�aur�t �5��-1 I,Ipo�r R�c1ae Rd �vev-Tt' 355-SCc�3 <br /> Owner Mailing Address �CitY� ZiP Phone <br /> J•J�10.Cl�Dw��S 21�C P.O. BOX 2�3q � L��Wooc� cj803(o 31.��4421 e�y86- <br /> Applicant /'p� xNey.. Mailing Address City Zip Phone <br /> V� <br /> Describe Proposed Work NPlnl S�� ` I Ne$1 � C VlC � � Y)�CI.C. <br /> '��1 I O S 'I"�' <br /> T� W <br /> Prolect Address(il known� �� „ � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and nole ihe lollowing as applicable: � <br /> • Property lines • Centedine ot street ♦A� <br /> • Outline and dimensions ol all eaisting and • Indicate Norlh V� <br /> proposed struc�ures on the lot • Show any proposed grading changes <br /> • Existing and �roposed ulilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THI�LINE O <br /> PERMIT CONOITIONS <br /> 1. All calls for inspection shall 6e made 24 hrs. in ativr�nce- phone 259•881 5. � � <br /> 2. All work shall be performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> L � � � <br /> , f/�:%L Ar./.fy c.-'c`d,:.i[ /N.�,-G,.'inc �'-n. StS��. O <br /> Jr. /�/�i-'L.C.eI.✓i/S%c% SiG-�G� L./.!>. /PfS�T.o/✓ ,sai.!> <br /> �.�C[% dF- L!n- �CL'Ei�-'4it/T / G�UhE- �U'�J'T� � <br /> ( <br /> � �c�c.srii��"C— /�z.'sf L'i[� /�.E'er'F.e,T /�'e-ST 6cr �1��E�L <br /> '� i'LETEc�/ DF�nvtiS//Fd 6fF��FI /�'EG�•c�.✓,i,'t.. �O��y�0U1 51'��n � <br /> li�.., <br /> ('��.ds?.c'L�lT.�/� �'f� �'EiJ cicle. �*n O <br /> 7 Q�. �.e' S/Jc SEiUE/' %d tj'r` �'O.VSi�'c�CTE1� � <br /> �fzoss G�r Tc� Ti/E ScuT.i! — r'F.� <br /> GGv..e Ot.G��/�S: /Z/lv/8S <br /> —�—� .— �,c�y G�f .c'flcf�OEl� <br /> ;,h', /�pf'C'iCd/(// T ����S.L_i`�E.�, ACKNOWLEDGEMENTOFCONDITIONS <br /> EA.SF�'�E�'�� �'` The undersigned owner/applicant hereby agrees lo hold and save harm- <br /> less the City ol Everelt Irom any and all claims lor damages, costs, <br /> expenses, or causes or action Ihat may arise �ecause ol installation <br /> ��� � /�" � . and maintenance ol Ihe improvement or other righ4ol-way use hereto <br /> �/r�"/6��'�"�°� �L��� �y�� applied lor and furiher agrees to remove same. upon notice from ihe <br /> ApFroved ns Eion �a�e City antl to replace pu5lic propertv damaged thereby. <br /> . �- �7 . � <br /> n . • A Q����//yJ � <br /> FINALINSPECTI ' Date ��u�- � ld"��s�' �y_/6�� <br /> Approved as ConsVuct Signature of App icant Date <br /> evcrett PUBLIC KS EP RTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED WITHIN <br /> O 32J0 Cedar Street 780 DAYS OF DATE PERId1T IS ISSUED AND THEREAFTER IS TO <br /> Evereti.WA 98201 BE DILIGENTLY PURSUED l�0 COMPLETION. THIS PEHMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF VJORK ON THIS <br /> PROJ[CT OV[R 90 DAYS DURATION. <br />