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8s �T <br /> Date�' /- PuoLc woiha Ge� �1• /� <br /> aroa oco�-• <br /> hpplication For <br /> WORKS PERMIT P�DIi<WorkaFee s_ <br /> PUBLI�C ,��.�F�� — <br /> . Lna�oo�Fea P��a S <br /> Balance Due s � <br /> Print or Type Onty �S3 S� f ���/'/ <br /> �I��rt�� 3�ao -5�'` �s�. � 9�ao�� 33y-�,�.�y <br /> n c�`(� Ciry ZiP Phone <br /> Owner Mailing Address <br /> �i S <br /> r. <br /> I . C �kC�, ( t � <br /> �F City ZiP Phone <br /> — Mailmg Ad"ress n <br /> ,qpplicen! � <br /> U /C .. <br /> Describe Pr�posod Wurk _ <br /> _ .�� <br /> W y � <br /> � H � <br /> ��� N <br /> /s�i8 A L B — I/i.E'vi•uiti AG�E � <br /> PmjeGt Address�if known� � � <br /> Atlach four(4)copies o� plans for proposed work- Draw lo scale and note�Cenlle lice ol stree�able: � � <br /> • Property Lines • Indicate Idoit.� � <br /> • O u t l ine and dimensions ol all existing and � S h u w a n y pro posed g�dding ch�nges � <br /> pro0osed structures on�he lot � Show measurements H <br /> • Ezisling and proposed utilities Z <br /> DO NOT WRITE BELOW THIS LWE O 'y� <br /> � N <br /> PERMIT GO`IDITIONS ^ <br /> 7, �II calls for inspection shall be made 24 hrs.in advance� phone 259'881 5. � p � <br /> 2. All work shall 6e performed in accordance with this permit end current Ciry ol Everett Design and Construction � � <br /> S�andaids and Specifications. <br /> �. Call Location Underground Service 48 hre.bebre you dig.TOLL FREE NUMB[R 1-800•424•5555. N <br /> G2avEt. �'eaDc.tri�y / I�i,c.C•�.ci� A°"E• — O � � <br /> � E-�'/STiNlr � N <br /> FieO/n THE NOP-TH Si O E OF /5 TN. ST: .r0 WHEr'-E � <br /> TNE f'.�'ESEn» S j i>CCT D.�Of'S OFi� /itlTc� S�✓o^��'� � <br /> S//d c C �E PAvEO �''E,� [-!� OF �iir.�tTl ST.o.c�:Od�c'.D � <br /> �t/UmdE/: ,��G — SPE�c:aL %��Tf•�//rl r�'EE'l, O � <br /> a � <br /> � <br /> � <br /> n <br /> m <br /> ACNNOWLEDGEMENT OF CONOITIONS <br /> TY.e undersigned ownndaOP�icant hereby agrees to hold and save harm� <br /> �—� less the Ciry of Everett trnm any and all claims for damages, cosls. <br /> — � expenses, or causes of • i ihat may arise because ol inslallalion <br /> �� �'L ., / and niaintenance o� the � ������cvemenl or other rigM�o��way use here�o <br /> � � L/y���S applied for and I�rlher agrees to remove smm�febYn notir.e ��cr� 'he <br /> �ale �ity and to replace public properry damag^� <br /> Approved lor Construction <br /> / � /� <br /> l��6P'— S--�tJ_tFT ��'/-�f iG .20 f'3� <br /> �— /� /J" /'c1l Dat=. <br /> Date <br /> FINAL INSPECTION Sig ature ot Applicant <br /> �paroved as Conslructed µ•pRK AUTHORIZED BY ThIIS PERMIT . ...ST BE STARTED WITHIN <br /> evcrett PU�LIC WORKS DEPARTMENT 1g0 DAYS OF DATH PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DIUGENTLY PURSUED TO COMPLLTION. THIS PERMIT MAY 6E <br /> Everetl.WA 98201 CANCELLEG 8'f THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8875 PROJECT OVER 3G D�YS DURATIJN. <br />