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_ � <br /> r <br /> '� <br /> r .�c�'3 P�o���wo,k,P„m��. �3�a� <br /> Date � <br /> 9Iap.0eD�-• <br /> Applica�ion For �Ec�P _ <br /> PUBLIC WORKS PERMIT �`'��..�i PUbTo�FaeFae a ^d — <br /> less�ppl Fee PeiE S----A-- <br /> � Bel�nce Due S <br /> 1� - <br /> Print or Type Only i,�.o..�_as�_ �o�f � <br /> c.+o.E)(; o2S.2- c�lv/ <br /> /1 /91/T���O.�C�'/�J'L 7�J�'J s/<K^�fT/� .G/� �F� <br /> pw� Mailing Address City Zip Phone <br /> cS�Y//Lc <br /> qpplicent Meiling Address Crty Lp Phone <br /> C� �T�i�G�� .O�/ItC /j e�G�� U� <br /> Desc�ibe Proposed Work .BiP/NG ��f� ^ � �y� <br /> �f - /�/'9 �'.GE� .r /C ��/�id�O�E' <br /> T'- .C'/7C E Gvc�iF' /� � <br /> W <br /> Prolect Addres5 PI known) �'l'33 S/<l��� /1�� � <br /> Attach four(4)cop�es ol plans lor proposed work-Draw to scale and note the lollowing as applicable: �I <br /> • Property Lines • Cenledine of slreet � <br /> • Oulline and dimensions ot all existin9 antl • Indicate Norlh <br /> proposed structures on the lot • Show any proposed gra[ing changes <br /> • Existing and proDosed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls lor inspection shall be made 24 hrs.in advance-Phone 259•8815. � <br /> 2. All work shell be pertormed in accordance with this permit and wrrent Cily ol Everett Des�g�and Construction <br /> Standerds antl Specifications � <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBEH 1•800•424•5555. <br /> f( /n�Sf'c C 7c'�.e /S' 7� a�'� C'��G :s� .�?j�il��k.C,r i� O <br /> �i'/„"C�L� OF LCJUiC'� %/YJ��LrC�,e 4J/LL �� <br /> �p�'G�SF��tIi GtJf/cn� �/�C/�/`�4TL� /l�c.+!/�'J' u/� � <br /> /,�f�/11�- /f �i9nJ�' /S' .O�J'T�u«F`�/.Oi9�i9Lc�' �/� <br /> ,yp' \// <br /> iT G✓�LG' v''F �'Ff�/� /P':6�L'. cvv.P� sT�/���'o O <br /> c c0/�'�'CT�o n� �� Ti�� f'c�Gl c GC.7r�.�' A <br /> f�i Tff ^ Ii <br /> /�vSf�-�-rv�, <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby egrees to hold and save harm- <br /> less Ihe City ol Everetl irom any and all claims tor damages, costs, <br /> � expenses, or causes ol action ihat may arise beceuse of instulletion <br /> q��� and maintenance ol lhe improvement or other righPOFway use hereto <br /> � applied for and further agrees to remove same upon notice irom the <br /> App ved br Construdi Date City antl to replace public properry damaged thereby. <br /> L o-� -�� J <br /> FI INSPEC710N Date Date <br /> Approved as Constructed Signature ot Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> everett PUBLIC WOFKS DEPARTMENT 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ce�ar Streel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet4'NA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8815 pROJECT OVER 90 DAYS DURATION. <br /> L � <br /> L J <br />