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I <br /> 1 <br /> � C � � � df� '' � 8� ��s <br /> Pu�i¢'Noeka Permu/• <br /> Date , `3 eior oeo� • $L-� 1 ` 3 <br /> Applicalion For D E C �9 1983 <br /> Pu011c Wo�ks Fee �,0 �O �O <br /> PUBLIC WOHKS PERMIT Ta,e�Fee $ — <br /> ..... S <br /> ...••.••....•.'. Less ApPI Fee Paitl - <br /> . <br /> CITY OF EVERETT 7�0. o 0 <br /> 9alanw Oue � <br /> Print or Type Only pi•�'ic Nlorks Dept. ���9� <br /> - . � �,,y�,., <br /> •�; �,•� •� '� l;( �EL � l�ti" 'C� <br /> ��i • . r�/��"� ��,��- ��� ' i �C � i �' i ���� ` � Ph00@ <br /> Owner <br /> MaJing Address City Z�p <br /> �� �L��V� �< City Zip Phone <br /> qpplicent Mailing Address <br /> ;y'S ft c<. ,-i � i(�iJ( �"i✓��r'rf'r i< 1,Pi l� :U��t <br /> Describe Proposed Work � ' ' � <br /> _ � — W <br /> 5 0 8 r� ev,e Gt/a �.!;t>:y U� ,.;� :� , � .;, .�", �' <br /> Prolect Address(il knawn) � <br /> Atlach four(4)copies of plans for proposed work- Draw to scale and nole�Cenllerline of slpee�cable: � <br /> • Property Lines • Indicate North <br /> • Outline and dimensions ol all exisling and � Show any propo�.ed grading changes <br /> proposed structures on the lol � Show measuremr.nts M <br /> • Ezisting and proposed utililies W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls tor inspection shall be made 24 hrs. in aAvance- phone 259•881 5. <br /> 2. All work shall be performed in accordance with lhis permil ano.:���rent City ol EvereU Design ond Conclruclion <br /> Standards and Specitiwtions. � <br /> 3. Call Location Underground Service 4B hrs. belore you dig.TOLL FREE NUMBER 1•800•424•55 . <br /> O <br /> � <br /> N <br /> O <br /> �. <br /> AGKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apPlicaM hereUy agrees lo holu and save harm� <br /> less the Cily ol Everett from any and all claims lor damages. cosis. <br /> r _ //� eapenses, or causes ol action that may arise because of installation <br /> ��� / and mainlenance ol lhe improvemenl or ot,l�er(ight-ol�way use herelo <br /> ,��� �'Z' r—f3 appPed for and furlher agrees to remove saliic� upon notice Irom the <br /> Date CitY enTJ to replace Qublic property damaged thereby. <br /> q df onstrur,lion .� , . <br /> S Z� c`�° ���`( ( �� `/ ' � <br /> _�J� �, , ;:�:, �:: , <br /> Date I ant Dale <br /> FINAL INSPECTION Sip6aWre of App jc <br /> Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUS7 DE STARTED W�THIN <br /> everett ?UBLIC WORKS DEPARTMENT ��180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> � 3200 Cedar Slreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERA117 MAY B[ <br /> Everett.WA 98201 CANCELLED B'!THE CITY UPON ANY STOPPAGE OF VJOFK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />