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7 <br /> t <br /> � <br /> � <br /> � <br /> ,� <br /> Date f '� Pu�hG Wo�k�Permil• � zz� <br /> ApplicationFor Biao�oen� • �a�-7�i Ssa <br /> PUBLII� WORKS PERMIT Pubi¢Wmks�ee - <br /> Tolal Fec s <br /> LeSs Appl Fec Paid 5 <br /> eai���r o�a 5� <br /> Print or Type Only <br /> />.UDY ,Cu .,,� vsii viE�� � F�,F-�f--rr ra Z�3 asi— � 9� / <br /> Owner Mailing Address City Zip Phone <br /> t/� <br /> ,6��n �._ J- �< <o //7-/ �. 1��i1�1.uE � �I-��o..� rl'S�sS" 33Y— <br /> ' qpplicant Mailing Address Ciry Zip Phone <br /> Describe Propased Work < --- <br /> i <br /> -- W <br /> rrolecl Address lif known) ��� ^J � �� � <br /> Attach lour(4)copies ol plans for proposed work- Draw So scala ano note the lollowing as aFP�icable: � <br /> • Properry Lines • Cenierline of siree' ♦A <br /> • Outline and dimensions ol all existing and • Intlicate Norlh V� <br /> ¢�� proposed strudures on the lot • Show any pwposed gratling changes <br /> a� � � • Ezisting and proposed ulilities � SLow measuremeNs � <br /> DO NOT INRITE BELOW THIS I.INE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current Ciry of Everett Design and Cons�ruction <br /> Standards and Specilicalions. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1•800•424•5555. � <br /> �'� <br /> o6izei90 io:.��ar; 000aazsis �F� <br /> i �N000�4`;f:D <br /> ELDG 4108.00 N <br /> C SF'CH #4.50 O <br /> DFT.20 �20.00 <br /> �HECf; #�1.'u^.i0 � <br /> � ACKNOWLEDGEMENT OF CONDITIONS � <br /> 7he undersigned owneNapplicant hereby agrees to hold and save harm- <br /> less Ihe City of Everett Irom any and all claim�� tor damages. costs. I <br /> expenses, or causes of action ihat may arise hewuse of inslallation '� <br /> �� e1�1 G� '� —��--� and maintenance ol Ihe improvemenl or other right-of-way use herelo <br /> �� < < applied lor and lurther agrees to remove same upon notice Irom the <br /> Approved lor onstrucf n Date City and lo replace public property amaged ihemby. <br /> -�ti�� � — � '�'� ��7 , , �— <br /> FI L INSPECTION Date I . <br /> Approved as Consiructed Si nature of Applicant D�te � <br /> WORK AUTHORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br /> everetl PUBLICWOPKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> � 3200CedarStreet 8E DILIGENTLY PURSUED i0 COMPLETION. THIS PERMIT MAY B[ <br /> Everett.WA 98201 CANCELLED BY ThIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Pho� �:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> i <br /> � <br />