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8�-3z� <br /> Fu��ic Wo��s Permit� ��� <br /> O8t8_� BIOB.DeDI.♦ <br /> ApD���ationFor p�oncwo�bFee s-,_ <br /> pUg��C WORKS PERMIT TotalFee <br /> Les��ool Poe Pue S �� <br /> Be�ence Due <br /> Print or Type Only /�gpm 3SS-9o9� <br /> Z75 3,s�- 66l16 <br /> �/ R9is/ .���"fr���� ml//!'/ Phonr, <br /> � Zip <br /> _�� �I Ma�ling Address <br /> Ow�er <br /> Z�p Phone <br /> SLJ�E� Nlviling Aedress ���y <br /> ApPlicanl <br /> E .eii✓G <br /> �cPuddi�/� �F SiTE --� <br /> Deacribe Proposed Wo'R <br /> i <br /> W ' <br /> _ s� � <br /> Prolecl Address(if known) � <br /> Attech lour(4)copies of Plans lor proposed work•Draw to scale and no:e�CQ�1eW��e ol sir�ee�able: <br /> • PropertY���es • Indicate North <br /> • Outline and dimensions ot all eaisting and � Show any proposed grading changes � <br /> pmposed strucWres on the lot � Show��easurements <br /> • Exisling and Proposed utilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS ' <br /> 7. All calls for inspect`o^shall be made 24 hrs.in advance� Phone 259-881 5. <br /> 2. All work shall be Perlormed in accordance with this permit and current City ol Everett Design and Construction � <br /> Stendards and Specifications. <br /> 3. Call Location Underqround Service 48 hrs.before you dig.TOLL FREE NUMBER 1'800•424•555 • O <br /> �, �jfOG�L9�T %O GEA✓E �/'�'�'oX, j�o � oF //E5 E7ATo�✓ <br /> ,q�o,dU /,�/Es,- E,✓� oF P,ear�e>y'. <br /> Cv.�T,�°oG T° �`� � <br /> 5. TE•�s�a,cA,�y E�'OSiC�tl/EDi�ENTl�Tiv�✓ N <br /> , � � av r�. PUJ�,c i.va�.rs r^�JPE���� O <br /> jJONE /�5 L i'e- C i r_'L <br /> AS ,-�� ���� ��,SES - a <br /> �, .9,eE9 To $� S�E- or"� �9fvEi� CJo.� f' Cnr�PCETE. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapPlicant hereby agrees to hold and save harm- <br /> less the City ot Everet� Irom any and all claims for damages, costs, <br /> eapenses, or causes ol adion lhat may srise because ol installation <br /> d /A� and maintenance ol Ihe improvement or other right-o4way use hereto <br /> �-ZC� ' �o� ly o// applied Icr and turlher agrees to remove same upon notice irom the <br /> '�� Date Ciry and replace public perty damaged thereby. <br /> Approved or Cons uctian � � L <br /> � �L �� <br /> � " I Date /✓�'� � <br /> FINA I <br /> SignaWre of ApP��cant <br /> App�o as iructed yyORK AUTHORIZED BY THIS PERMIT MUST BE STARTE� WITH <br /> PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> everMt BE DIUGENTIV PURSUED 70 COMPLETION. THIS PERMI7 MAY BE <br /> � 3200 Cedar Street GANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> EveretL WA 98201 pqp�ECT OVER 90 DAYS DURATION. <br /> Phune�. 259�8815 <br />