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uate 6��I �O� P�CIic Works Germn• �� _ Z7� <br /> Appilcation For Biaa oeo�.• <br /> PUBLIC o:�ORKS PEcMIT PUbTo�e���° • — <br /> Leu Aoo�.Fee P�ia S. O <br /> Balence Oue f �S� <br /> Print or Type Only <br /> �, �CFf4r��S � 1/GE�¢-'nRn1� <br /> ��or+N FL�u� rnFr.� i,.� _ � °• �aiY-�9a90 �Vcc2si i 9�3zoL 3Sb-Siv/ <br /> r_ Owner MaiGng Address City 2ip Phone <br /> /l�mw,� � �,�._,r,�y <br /> `�MMCLL�AL—.,-C����. �s !� � d� ���e �,,,�,,,�wo� 5"8o3c- 77B-z_Z� <br /> Applicant Mailing Address � City Zip Phone <br /> Describe Proposed Work ` �A�GT.�l4G 1 �N�7n iG/1�� �oLAb E �D y <br /> Qf W <br /> ProjectAddress�ilknown) -�?q7��61_�� I�Lv.� �E7Lc7T� � <br /> Attach lour(4)copies of plans for proposed work• Draw tc sc3ia and note Ihe following as applicable: � <br /> • Properry Lines • Centedine uf street � <br /> • f�utline and dimensions ol all existing and • Indicate North <br /> pmoosed structures on the lot • Show any proposed grading char,pes <br /> • cxis!�•ig and proposed utilities • Show mcasurements � <br /> —� DO NOT WRITE BELOW THIS LINE <br /> PEFMITCONDITIONS �/17/� Zi� �I � <br /> 1. All calls for inspection shall be made 24 hrs. in ad�ance- phone 259•88�$. 7� � <br /> 2. All work shall 6e peAormed in accordance wilh this permit and current City ol P.erett Dc�yrr�d Cor�t�n � <br /> Standards and Specifications. � �•� <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 7. CiTj/ �,PE'E7S fi'.t-'E' j� 6E �`EoT CLE.s+�' dF ll�ii'T O <br /> � ,vE'Y3rPiS Ar f�LC TimEs L�G.C'i.t/G Co.v5��1UCriON, <br /> JjvS7 SU'P.PFSSivi✓ /5'Nd ST.PH'ET CIFFJN�N�* it�(LCT GYCG/,e. � <br /> qs �iQE�TE.� B • Ti,�E t'�6'��c c�Jo�e�r L��ECTo.� . � <br /> ;S; E,Qr_��! F,eo� Exc�9v9Tin� SN�9cc BE �A�C=� O <br /> �er o�✓ -To.v,v Fca,s�' �'.PoPE�eTy aNL� - i�ds.- ,vor <br /> ,�` �//mPED i.tl ST,PF9n� COi2?/DO'/` � a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereUy agrees to hold and save harm- <br /> -- — less the City ol Everett Irom any and all claims for damages. costs. <br /> /� / ex enses, or causes of aclion Ihat may arise because of installation <br /> —_r������y�,C-� �f � 86 and maintenance ot ihe imProvemeM or other right-obway use hereto <br /> / ��� applied lor and f r agrees t re o same u on notice Irom Ihe <br /> Approved tor Cons uction ` Date City anC to re e rop ry m d {l�e�y. �//7/Q/� <br /> LGl��Y!/v"XI — - - ��' CJ��� <br /> '�f: <br /> ,r,•�[� I Z-`�3 , <br /> FINAL INSPECTION Date - � _ <br /> Approved as Consiructed ignaWre ot Applicant Oate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•9815 PROJECT OVER 90 DA'/S DURATION. <br />