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, <br /> Date �� � '' <br /> ->. <br /> ,� • oue�¢wons Pumn� _•"1 •�f�.;/ ' <br /> ApPiicalion For amo oeo�.• � <br /> PUBLIC WORKS PERMIT F�°;o„F�FQ1 :�yo�,j4 <br /> �eu�oo� Fee o•�a � <br /> Print or Type Only A�I�nce Due s 1� S�nB,3 3 <br /> .r�Fc, �' 70777 <br /> ./O/M/ �'Gu+e� �lF.G G's. 2NG. R o, �3eX� 9G 40 �✓EXE� ?8?A(o .�S(v'SlSD <br /> Owner Mailing Address Gty Zip Phone <br /> TitE M�iri,v � /},eeµ. /�ii ri��e,o �✓� 5'dfrns 98/a/ �!o¢-/P�O <br /> Appiicant Mailing Address City 7ip phone <br /> Describe Proposed Work G�L�/Q'/Q� �rc��r7/`/lj �� �rT�t�r/�� r"� �j� /O/S <br /> rr��c <br /> 2 go, o00 .�F. D �'i� �,c> �z�cT,eonuc's Ms�. Bt1�. <br /> Project Address(il known) _ �� �G�7 w� BLVQ. �V��r'r � <br /> Attach four(4)copies ol plans lor proposetl work- Draw to scale and nole the lollowmg as applicable: � <br /> • Properry Lines � <br /> • Centerline ol sireet � <br /> • Outline and dimensions ol all e.istin�and • Indlcate Noitt. <br /> proposetl siructures on the lot • Show any proposed grading chTnges <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRIi[ BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls lo�inspection shall 6e made 24 hrs. in advance- phone 259•881 5. <br /> 2. All work shall be pr.riormed m accor0ance wlth this permlt and current City of Everetl Desiyn and Construction ' <br /> Standards antl Specilications. <br /> 3. Call Location Untlergrountl Servlce 48 nrs. belore you dig.TOLL FHEE NUMBER 1-800•424•5555. <br /> ._- i� Lc'/[ii�c'uc 7t!> i� , i='G �.' �'li�.�iS /!/'r'.c['cEl� � <br /> .:.�:' ?-,J i'Y- O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> -- The undersigned owner,�applicant hereby agrees to hold and save harm� <br /> Iess ihe City of Everet� Irom any and all claims tor tlamages, costs, <br /> __�� , , exGenses, or causes of aclion Ihat may arise because ol installation <br /> /..����, /� .�-,/'_-� j/J_ ;.� and maintenance ol �he improvement or other nght�ohway use hereto <br /> ApPrpved lor Conslruchon Date apphetl lor and further agrees to remove same upon notice Irom the <br /> Ciry and to replace public property damageA ihereby. <br /> I Z �� �� //_ �� <br /> fINAL INSPECTIO Date � � �/��/�'Fa <br /> Approved as Constructed �— <br /> igna ure of Appl� Date <br /> evcrett FUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHW . <br /> � :i2U0 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS ' <br /> Ecore�t,Wp g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMI7 MO <br /> I'hone: 259-8815 CANCELLfD BY THE CI7Y UPON ANY STOPPAGE OF WORK OI <br /> PROJECT OVER y0 UAYS DUFATION. <br />