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%i j' , -� <br /> �. � , <br /> Date (O a�oi��wo„i v.,m f�b ' 28-r <br /> Application For eiee oeo�.�_ <br /> PUBLIC WORKS PERMI'� FVEliclYorbFee — <br /> Tolai Fea S <br /> leas ApO�Fee Fe�a g 1l <br /> Beiance Duo S�� <br /> Print or Type Only - <br /> \` _ �J rh 9Bof/3 �3 � - LS�J%� <br /> �1.� G('C/.-'t�� 25�.30� — 5�s< —A�E ir/ �h9u.��Cr�O <br /> wner Mailing Addre55 City Zip Phone <br /> v ��.�.� _ _ _ <br /> A�plicant Mailing Address City Zip Phone <br /> Describe Proposed Work CO.rJSr.ecicr �/Eul _S'i.d�CF ���c r/ .t�ESioF.✓c E <br /> �8�.5- - - W <br /> Projec�Address(if knowr� � ��� � <br /> Attach lour(4) copies ol plans lor proposetl work�Draw b scale and nole the following as applicablr: � <br /> • Property Lines • Centerline al street /A <br /> • Gutline and dimensions ol all ezisting end • Indicate North V� <br /> proposed structures on the lot � Show anv proposed grading changes <br /> • Ezisting anC proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT C(JNDITION� <br /> 1. All calls for inspection shall be mads 24 hrs. in ativance-phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and cw�ent City cl Everetl Design and Constiuction <br /> Standards and Specificalions. <br /> 3. Call Lor,ation Undergiound=^rvice 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> �ww <br /> _/ <br /> O <br /> a <br /> ACKNOWLEDGEM[NT qF CONCITIONS <br /> The undersigned owner/applicant heteby aprces to hold and save harm� <br /> less Ihe City of Everetl Irom any and all -laims lor tlamages, cnsts <br /> � , eapenses, or causes ol aclicn that ma� a hecause ol installation <br /> / � L,� �j �o` and mainlenance ot ihe improvement o� �� right-ohway use hereto <br /> �`, ����T�y � applied for and lurther agrer.s ro remc. � ie upon notice irom the <br /> Approved for Construclien Pate City and t epi, e p�propertv dart. � �nereby. <br /> �7 '�.-� i-�%-✓ 7 U.�1 Q,/ <br /> FINAL�DtE�P TI N Date �' " � —` � ��/���� <br /> Approved as Constructed Sig ature of Applicant Oate <br /> everett PUOLIC WORKS DEPARTMENT WORh AUTHORIZED BY THIS PERMIT MUST 8E STARTED W,THIN <br /> � 3200 Cedai Street 180 DAYS OF DATF. PERMIT IS ISSUED AND fHEREAFTER S TO <br /> BE DII.IGENT�'�' FURSUED TO L'OMPLETION.THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON irIIS <br /> Phone: 259-3815 PROJECT OVER 90 DAYS DUR4TION. <br />