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✓ <br /> Date�� 1 Puni�c Wo�ks ru,mu. _s.�l'�" /��?� <br /> ApPlica�ian Por ame.oepi.. _�r � �—r�'ZR[1 <br /> PUBLiC WARKS PERMIT P�°°°W°fk6Fet <br /> ,��a�F�o s <br /> tess nnn� F�c Pa�a 5 <br /> Print or Type Only <br /> -�.n���. S ZC7P0 <br /> C IUrv1 C0 CDlt.i'�. Cc� <br /> s = 5 �j=� P�c��1c� �t- �clnn�d�, �i�rn..o ��� ,�3( <br /> Owner���4�"rq��p 3"r1` , MailingAddress City Zip I'hone <br /> `,ame, <br /> Applicant Mailing.4ddrr.ss City Zip Phone <br /> Describe Proposed Work �� L�'11�� �e5j���% <br /> —�����'N ' ��t r���l �� ��—�7—,/�i,i S <br /> Proiac:Address(it known� 2522 V�GWCYfS'f" �i/?i ,Ev2/C� � <br /> � <br /> Attach lour(4)copies of plans lor proposed�vork- Draw to scale and nole the following as applicahle: � <br /> • Property Lines • Centerline of sireet � <br /> • Vutline and di��ensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposetl grading changes <br /> • Existing and proposea utilities ! Show measurements � <br /> D(� NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspedi m shall be made 24 hrs. in advance- phone 259-8815. � <br /> 2. All wo�k shall be peJormed in accordance with this permit and current City ot Everett Design and Consiruction <br /> Slandards and Spec�'ications. <br /> 3. Call Loealion Underg�ound Serviee Ag Irs. befc�e you dig.TOIL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> � <br /> a <br /> ACFNOWLEDG[MENT OF COI'JDITIONS <br /> The undcrsigned owner/applicant hereby a9rees to h�. ,nd save harnr <br /> � less ihe City of Everelt from any antl all claims lor �amages, costs. <br /> expenses. or causes of action Ihat may arise because ol inslallation <br /> ��� � ` �_o and maintenance of �he iinprovement or othei �ighbol�way use hereto <br /> �`"�`�YY � —`� applied for and lurther agrces �o removc same upon notice Irom Ihe <br /> Approved for Consiructi /� Date City and lo replace public prcperty damagetl thereby. <br /> c� 1�}�! -�!-f' <br /> FINAL WSPECTION Ua�e ��� ��� �9—'�T <br /> Approved as Consirucled Signature of Applicant Date <br /> everelt PUBLIC WORKS DEP,;NTMENT WORK AUTHOIiIZf:D BY THIS PERMIT M11UST BE STARTED WITHIIJ <br /> � 3200CedarS�rceet 180 DAYS OF D�TE PERMIT IS ISSUED AND i�1EREAFTER IS TO <br /> Everett,WA 98207 BE DI�IGENTLY PURSUED TO COMPLETIO��. TIiIS PERMIT MAY BE <br /> Phone:259�BA7 5 CANCELLED BY THC GTY UPON ANY STOPPAGE Of VJORK ON TH!S <br /> PROJECT OVER 90 DAVS DURATION. <br />