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- , j <br /> �y� �(� <br /> Date�9 �y� 11 Punbc Worxe Perm�l• " >/' z.�, <br /> ���� <br /> oiaa oeo� � <br /> AppliCation FM <br /> PUBLIC WORK� PERMIT °°°'"w°'".`°° s _ <br /> Tote1 Fee <br /> Lesa Ano� Fee PeiJ S! <br /> 8 O BBIp11C8DY0 i��- . <br /> Pri�t or Type Only = � <br /> � � � <br /> N <br /> c'N CLAit,K iU31 l.l - �iZt- AVG CVCY_c-'-tT ��OI ZSZ-k97 <br /> Mailing dr � � City Z�p Phone <br /> Owner � <br /> � <br /> r <br /> 3 - MC <br /> Applicent <br /> Mai6ng Address GIy ZiD Phone <br /> DeSGribe Proposed Work <br /> F�GN G E AT I G 31 L�ICl NIOK -tH E �'-`-��rt�i Z Z o�z S o <br /> F l ET l i I�� F3E �N c �`rY 2 n � � <br /> W <br /> Project AdAress lif knowo) �G �I w��NbQ i � � <br /> � <br /> Attec�lour(4)copies of plans lor proposed work• Draw to scale and nole the lollowing as applicaAle: � <br /> • Property Lines • Centerline ol street <br /> • Outline and dimensions ol all ezisting and • Indicate North <br /> proposed shuctures on the lot • Show any proposed grading changes <br /> • Existing and Droposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> t.All celle lor inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be paAormed in accordance with this permit and current City of Everett Design and Construction <br /> Stendards and Specificetions. � <br /> 3.�all Location Undergrountl Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. <br /> Q. ,QIL ��CC tN C. tTY I�, O.k�, SEIALt f'y:-.- � �_'� Nic-,H O <br /> Cii1Z l.��S: . � <br /> �j. c^N 'i�1C j �`-'�il-� ETS'1' CCK NCti'_ W N�"l"Cr ALI.�f � <br /> M��13 � t T�� S'(. — �_ Ff7�N� FL-�Z � 5 ' Fc:iL �;i c, H'� O <br /> n�sro.tVC_� a , <br /> � <br /> �` ' 'S � <br /> � � " ACKNOWLEDGEMENT OF CON�ITIONS <br /> iS' <br /> The undersigned owner/applicanl hereby agrees to hold and save harm• <br /> less the City oI [verett from any and all claims for dameges, coats, <br /> expenses, or causes ot action ihat may arise because ot installation <br /> — and mainlenance of the improvement or other �ight-oi-way use hereto <br /> applied for and further agrees to remove same upon notice irom the <br /> Ap ed or Co � ction late �ity and to replace public property damaged �hereby. <br /> c.�� - i c. y/- io !C���(_ C CJ�fk 3�2��'J <br /> FINAL INSPECTION Da�e Date <br /> Approved as Cons�ructed Si�nature ol Applicant <br /> everett PUBLIC WORKS DEPARTMENT <br /> BORDAYSTOF DATE� PEFMIT ISESSUED AND THEREAF ER ISHTO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everel6 WA 98201 CANCELLED BY Tl1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJGCT OVER 90 �AVS DURATION. <br />