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i <br /> Date .'_ '. �t.-) �`�� , .. , �._" v�m��wo,k�r��m�i._ <br /> i�_��AppliCation For o�oc�DeN.• • �� <br /> PUBLIC WORKS PERMIT PuOiicWorxgFcc <br /> .o�e�F�o $ <br /> icss noot Fee aa�a S <br /> Ba�ancc Due $ <br /> Print or Type Only <br /> �rl' } '�)1 /� � a\ '1�1��/`l � r"� Jl�l 1 �!( '.�l`/_' ��1 . J 1',���c�7 c�I J;1— I�� <br /> Owner Mailing Address City 2ip Phone <br /> . � � I i� �7 =- .cn_ / _ <br /> �'_J Il'•�dl �'r i Il1ST ' �1 ���<r-l7 .'�"� ) <br /> Applican�l MailingAddress City Zip Phone <br /> Describe Proposed Work ���L� i`7�-r�����"Vr� � <br /> W �� <br /> ProleclAddress(ifknown) • �`-:� 1 `' i- f) �.' j�� � I;� <br /> Atlath four(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � I <br /> • Property Lines • Centerline of sireet � I <br /> • Oulline and dimensions ol all exislin9 and • Indicate Ncrth <br /> proposed slructures on ihe lot • Show any proposed grading changes <br /> • Existinc� a��id proposed utilities • Show measurements � <br /> � <br /> DO NOT WRITE BELJW fH15 LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 2A hrs. in advance- phone 2$9•881 5. � '. <br /> 2. All work sha!! be perUrmed in accordance with this permit and current Ci�y ol Everett Design and Construclion <br /> Standards and Specifica�ions. <br /> 3. Call Location Underground Service 48 hrs. befo-e you dig.TOLL FREE NUMBER 1•800-424-5555. � ,, <br /> f�"C/B.°/l Gdv,c�,f_f' /�Ei°rn-T i'✓ri;� �cFG�U%C�-� -�/�/.97 O <br /> �'��� � <br /> /� SiDr �/� <br /> J��JG� ��.POvrF Tn dE l�cu/E� AS �'<GjUi�i�l� [ ) <br /> ,a[/ .f�U/GOi�U ��c�9G. � <br /> � a <br /> �E,�oc,TF c�' in.vy ci E' 7>o.vF /��'7�2 jv,�D,n/�r ,�' <br /> C'CYVSi.CUG��Q Si�/cE Tf/E/�E �.n.n.F.9.�t 70 BE i('OD/�7 <br /> `�,[� (�d0�'�"' /y.c'Ot��/D .f�U�LlJ��✓6�, ACKNOWIEDGEMENTOFCONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Cily of EvereU Irom any and all daims lor damages, costs, <br /> expenses. or causes ol action ihal may arise because ol installation <br /> and maintenance ot lhe improvemenl or olher righ�-ol-way use hereto <br /> applied for and lurther agrees lo remove same upon nolice Irom the <br /> Approved for Construction Date Cily and to replace public property damaged lhereby. <br /> FINAL INSPECTION Date r� `�1-f7~/`� / / � `� > �L �� / <br /> Approved as Conslructed Sign�lure of AppJ—�- licant �— Date <br /> everett PUBLIC WORKS LEPARTMENT WORK AUTHORIZcD BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Ce�ar Slreel 180 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT(�VER 90 DAYS DURATION. <br /> {. <br />