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Date S�'9 9/ ����.�wo,.�Pe,m��. 9v _i�;�_— <br /> Applica�ion FOr eiaq oea�.• _ <br /> PUBLIC WORKS PERMIT P�b��=,��«a�eB <br /> ,o�a�F�� s <br /> Less RppL Fee I'aia S <br /> �' Print or Type Only Ba�r�=Qo�e s - � ' <br /> ;��L,;,,,�y ««�- .f�d. <br /> wt <br /> �i�l�1� ��So/� 5��/7- SiL✓ai-Ti'n. Ln. �v�r�f/ 9BZo.� (0 2 3- 7SBU <br /> Owner Maillny Addiess Cd� Zip Phone <br /> 2S�'' /�o?O <br /> .S'o.,�e. h�,�� <br /> Applicant Mailing Address City Zip Phone <br /> Coi�sfi'ua� �Cnce �� Yife L7�� C, i_�,P��/�f_ <br /> Describe Proposed Work � 6 p <br /> o� G�.Y+.v <br /> W <br /> Project Address(if known� ��7- — Oill /r�v��iL �o � S/p�f O� 7�l- L <br /> Attach four(4)copies ol plans lor proposed work- DraH�to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all existing and • Indicale North <br /> proposed siructures on Ihe lot • Show any pwposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW TfiIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls foi inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and curreN Ciry of Evarett Design and Con�truction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 1•800•424•5555. � <br /> � /`J"�_. �.�7` �nv� z�m,�.� rea� izvq�.i�inv�»,.�v- . ^ <br /> �(� �a� /'l�4X /�llr�i�, ti�-� � n U�/ �/ <br /> S J/��(� � '"`-'µ1 �QCM/L �,! .C�dR OJ iC/LCo Q.2f4i <br /> �� .c�r/ ¢��i.c2.,� LJt.L'( G� /Zl�?f%(t-Gt;� �4L � <br /> /�/I120?/'Gi'y �` — .�L-!n %" � <br /> � (J <br /> . O <br /> �� /�z�,�i.�.v>ac�»�.; �,i� J ho��.� <br /> �n. Fe.��. m�,�t G�- � �s�>,� <br /> �� ���;.- �� ��;�Y„ a <br /> � ;� <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> The undersignr.d owner/applicant hereby agrees to hold and save hann� <br /> less the City ol Everett irom any and all claims for damages, costs. <br /> // � eapenses, or causes ol action that may arise because ol installation <br /> `�.�,'�.4;�..�/�L J ��,�� and maintenance ol the improvement or other right-of�way use hereto <br /> ��� �� � applie for and furlher agrees to remove same upon notice Irom Ihe <br /> Approved for onst��� Da�e Cit n to replace public rop�damaged thereby. <br /> � � f� ��� � �� �2�� � �� '����9/ <br /> FINAL INSPECTION Date <br /> Approvetl as Consiructed Signature o�Applicant Date <br /> �Ar� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br /> 3200CedarStreet 780 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA98201 BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone�259�8910 CANC[LLED BY TH[GTY UPON ANV STOPPAGE OF WORK ON THIS <br /> � PROJECT OVER 30 DAVS DURATION. <br />