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� <br /> �y��� , `/ <br /> Date �// �/ PuercWo.k�Parmn• 7 ���5 <br /> AppliCalion Fof BIpQ Oeot• _ <br /> PUBLIC WORKS PERMIT P�°;oW eeFee s ��— <br /> Lew Aon� Fee P��a = <br /> Print or Type Only Bnl�nce Due s �� <br /> �-��di7� <br /> �I=Eyif ii� i�l_u K� /�� T- G C G� �n� c <br /> Owner MaiGng Address City 2ip Phone <br /> i�� <br /> `'�� I ir4 ( nn��i. ?. i' P `1 AI/� AI• S�A771.� GkB� — 'I7 'ld <br /> Applicant Mailmy Address Cdy Lp Phone <br /> Describe Proposrd Work L � �-.ii.71 G A1 C F Th'A1�[—A `t h� C li (Al(, F3 ,� R!��c ia ��r <br /> �� n�.�:2 c x S�; c F%. i,v�c?. <br /> -- � <br /> Project Address(it known) _ � <br /> Attach fow(4)copies oi plans lor proposed work- Draw to scale and note the lollowiny as applicable�. �� <br /> �l Property Lines • Centerline of stree� � <br /> • Outline and dimensions of all e.isting and • Indicate North <br /> proposed structures on ihe lot • Show any proposeC g�ading changes <br /> • E.isting and proposed utilities • Show measurements � <br /> DO NOT WpRE BELOW THIS LINE <br /> P[RMIT CONDITIONS O <br /> t. All calls lor inspectlon shall be made 24 hrs. in ativance- phone 259•881 S. � <br /> 2 All work shall be perlormed in accordance wlih ihis permil and current Cily oi Eveiett �esign antl ConsUaction <br /> Standards and Specilicalions <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �f,� �/�P��(� liJ/c.c_ ��y"��.'�' le,��i��.,� or /�.�i�/�C� <br /> � �'�".C-�c�A-� O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> Thu under�iyned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Cdy ol Everetl from any and all claims loi damages, costs, <br /> _ � �� expenses, or causes of action Ihat may anse because ol mstallatinn <br /> /% /��jc� and maintenance of the improvement or oti+er nghbof-way use herrto <br /> — "" � applied lor and lurihei agrees to remove same upor. not�ce Irom the <br /> ' ,�ovedlor Cons c�ion �a� Cily and to replace p�blic properry damaged it+ereby. <br /> FiNAL INSPECTION Date QQij!1Lh"�l ��1Gnl,._., � /� — <br /> Approved as Conslructed Signature of Apphcan� Date <br /> cverett PUBLIC WORKS DEPARTMENT �'✓ORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> � 3200 Ceda�Sireel 180 DAYS OF DATE PERMIT IS ISSUED AND THF.R�AFTER IS TO <br /> Everett. WA 90201 BE DILIGEN7LY PURSUED TO COMPLETION. THIS PERAIIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 50 DAYS DURATION. <br />