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�8t@ � /�//� / PuCLt Woa�Parm�it• �� �� <br /> �%SJ <br /> Bitlq.Deo�.• <br /> Applicallon For <br /> PUBLIC WORKS PERM�T P°""""°".`.. '� " � <br /> Tct�l Fsa s <br /> Len�Do�Fee P�iU � <br /> B�I�nce Dne f �� � �� <br /> Print or Type Only 6 �b 3 <br /> 1 Gwner Mailing Address City Zip Phone <br /> �l�1L� /^i C�Q pf� ��C 60L} l-1' s"C`ra/r ALS `�$��6 �34 'c 7�S rJ <br /> Appllcent Mailing Address CItY ZiP Phone <br /> Deacribe Propoaed Work w��, ��N�� "'� ��—�`(���� • <br /> � <br /> I <br /> � -c /� W <br /> Pro)ect Addresa(if known) O � 3 8 �9 J �1 O("e. Fi J G, � <br /> Attech four(4)coD�es of plens for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Linea • Centerline of street � <br /> � Outline end dimenaiona of all existing and • Indicete North <br /> proponed atructures on the lot � Show any proposed grading changes <br /> • ExlstinB end propoaed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIUN i <br /> 1. All cells for fnspecti�n shall be made 24 hrs in advance• phcne 259•8815. � <br /> 2. All work shell be pen�rmed in accordence with this permit and cur�ent City of Everett Design and Construction <br /> Standards and Specillcetiona <br /> 3. Call LxaUon Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> `�. �j�+l�an.�-� 0. G,C��o.,..r�r?/`CS V1P lS' C� �.....�-ic C, i- `f-�^e O <br /> \ n J JV'.��� <br /> jhorc !�`�e (' ' 1- <br /> S I o �e Sd-••4a,1.� �u..� �o _� <br /> �,1 �? 5 s u � �v� a-+'-C W\ � 6l 1" � v c�ic l� fT � <br /> I,Z.�Su.� c.'... . <br /> i.-. 1''�a� U t-� � � �3 � <br /> a <br /> ACKNOWLEDGEMENT QF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> less the Ciry o� Everett fmm any and all claims for damages, costa, <br /> � /�� expenses, or causes of action that may arise because of ir.etalletion <br /> �r' and maintenance of the improvement or other right-ohway use herelo <br /> i�� '7� 9 fy applied for and further a rees to remove same upon nofice trom the <br /> proved br Construction Date City and r ee publi properry damaged thereby. <br /> 2 �-r9� <br /> FINAL INSPECTION Date Dete <br /> Approved as Constructed Signature p' an <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED DY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8815 pROJECT OVER 90 DAYS DURATION. <br />