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Datei�`� 7 4 2 3 <br /> Publ¢WoiMs Permil• <br /> Applicnlion For elnp Dept� ��� <br /> PUBUC WO�RKS PERMIT P�bLCW,--- <br /> Totel Fco s <br /> LwsFnnl fe•Peiu s <br /> Print or T Bnlance Due S �� <br /> ype Only <br /> LX—J�.'A I Y1��;2 �����_��o��-��r�/ / <br /> Owner MailingAdd�ess Cdq Zip �T�Fcne <br /> �1��1 t �'�z{ n �. Pr-t��1� �;i r—.,-�T 4��� �q�-�.,p <br /> Applicant ailmg Address City 2ip Phone <br /> Dascribe Proposed Work I/_ lY'��., `�'1!� <br /> ProleU Address(il kncwn) �� — �E � � <br /> Attach tour(4)copies of plans lor�roposed work• Oraw to scale and note Ihe loliowing as applicable: � <br /> • Property Lines • Centeiline ol sheet � <br /> • Outline en0 dimensions of all ezisting antl • indicate North <br /> proposed structeies on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO IJOT WRITE BELOW THIS LINE O <br /> PERMIT CUNDITIONS <br /> t. All calls toi inspection shall be made 24 hrs. in advance• phone 2$9$8�5. � <br /> 2. All work shall be performed in accordance wi�h�his p��. '��t and current City oi Evorett Design and Construction <br /> Standerds end Specifications. <br /> 3. Ca�l Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �(6bF- Toi' l�.t�A....�96E C9.y'/Lk� �{ Loti.�E'c.-Eo T�, O <br /> PL/.j�/C l�,pqi.�i L/NE O.t" �.Q�/ !J!•t�' B9n/.�' , �T <br /> Ch'i✓ BE TiEo �i✓%o C�Jrc,yB,nl„✓ 9r F,c•o,f/r ���' GOT <br /> O�P T�G-.✓f Li.�.•E� %r- f� �p� �.c'S/c2/EGL . � � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applican�hereby agrees to hold and save harm• <br /> less the City o� Everett Irom any and ail claims lor damages, costs, <br /> � expenses, or causes of action �hat may arise because ol installation <br /> ��f._�_��� 7 /U y� j and maintenance of ihe improvement or other righbof-way use hereto <br /> �'��� applied lor and further agrees �o remove same upon notice from the <br /> Approvetl lor Constr c � � Uate City and to replace public prope y damaged thereby. <br /> l <br /> �,r, �' G_1 �� Q <br /> fINAL �NSPECTION Date til � /�� �''�o--�-- 9-ir-g <br /> Approved as Consiructed Signature oi Applicant � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Streel 180 DAYS OF DATE PEf7MIT I� ISSUED AN� THEHEAFTER IS TO <br /> Everefl.WA 98201 BE DI�IGENTLY PURSUED TO COMPLETION. 7HIS PERMIT MAV BE <br /> Phone: 259�8815 CANCGLLED Bl'THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OV[R 3c oavs nu�vniioN. <br />