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. <br /> , � <br /> � 9�-i3� <br /> Date�I Pom�c woike Perm��• _ <br /> eiaq.Dao�.• <br /> � App�ication For `�� <br /> PU�LIC WORKS PERMI'� Publ¢worFaFee <br /> TOInIFee s <br /> C� Lev AOVL Fee PaiE S� � <br /> � Q p Bnlance0ue S �� <br /> PriM or Typs �nl� '�: Q1 <br /> � M, �; Do2 -3z2-yo-oa�i8 - <br /> , g3/ <br /> � ,q ti,�yN S 7 c��sr �a._�r wA. g�.�o3 3y>-�isz�s <br /> Owner � �r ra x Mailing Address City Zip Phone <br /> � n�- "� <br /> � oa <br /> 1�t�4/� A• M�?� '�"' ba� wtsr L/� fv�,Fsrr G�A 9&.���a 3y7-�isc�s— <br /> Applicant Mailing Address City Zip Phone <br /> AOL �✓AI I�TD /� � US�� RAC,C�h�DE I}tpfd /J�f�tLY A�I£N27�n_ <br /> Describe Proposed Work �_� , �l <br /> �,sr�NRo�cS Pkof�RrY 7CJ .TNs -��ru. USE �NTS d..�2r /�uX APRox / > >a isb S'�S'_ <br /> FiF T�l.yt'Fn �"�V A�T TU n/fKf OJtJ��fVLL RAcK YR � <br /> u � S LN � <br /> i a-.,�� �,cc r Dt £NEiI f rT c.�A . QB7o-; � <br /> Proiect Address(if known) � <br /> ' A!tach tour(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> .� • Property Lines • Centerline of street � <br /> • Outline and tlimensions ol all exisling and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> � 1,All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br /> Stendaids and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREF_NUMBER 1•800•424-5555. � <br /> � /-. �/?O(J�r.a�ei � �,�y �tQ�2�cov� Q..n4'/OI^ O <br /> Y1�ro-,u.;,--� C'o„�o-r o� o'-viu'-�a0 �iy -x`� PC�c <br /> �vo� ��,�t�o-v • � � <br /> S � ,Sp�„u� a�i.c .�o f c, ,�a�-f- c�r�.,,, a� a.(O O <br /> i[.y+atH � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignr.d owner/appllcant hereby agrees to hold and save harm- <br /> - less the City ot Everetl Irom any and all claims lor damages, cos�s, <br /> expenses. or causes of adion ihat may arise because of installation <br /> � /o �> i/ �� 6/ ;nd maintenance ol Ihe improvemenl or olher righ�-ol�way use hereto <br /> ` Bj0'ay�y 7� � pplmd for and furiher agrees to remove same upon notice trom �he <br /> Approved for Cons�rucf n Date Cily and to replace public p�operty damageJ thereby. <br /> / `����L' .. . �A — �-/r� ' //' /�/ <br /> FINAL INSPECTION Date _��- ' ���Y", pr at <br /> Approved as Cons�ructed Sigt�ture of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSD[PARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Strnet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> EverelL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8010 pROJECT OVER 90 DAYS DURATION. <br />