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Date�,l�5 �J-�' �J <br /> PUCLc Waks Pnrmii• V � G�� <br /> Application For Bma.oco�.� �,�`����5�/ � <br /> PUBLIC WORKS PERMIT P��I¢WakSFee <br /> ,o�a�F�� s <br /> LessApPl FeePaid $ <br /> a,�A�«o�a s 35"OU <br /> Print or Type Only �93 6 <br /> �o� Lui�c, jGl�7 /�r,�r� �i���6� Ev�>iclf %��:U3 � 5� —/) 7 � <br /> Owner Mailing Address City Zip Phone <br /> S�,s, � <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �V P[t) l.1 �ii.Vi�r(✓.f ( [rr JC(i�r�- <br /> W <br /> Proiect Address(il known) , � � � ✓ � <br /> Atlach lour(4)copies oi plans lor pwposetl work- Draw to scale and note ihe lollowing as applicable: � <br /> • Property Lmes • CeNerline of street � <br /> • Outline and dimensions oi all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE B[LOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calis for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current City ol Everetl Design and Construclion <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1•800�424-5555. � <br /> � A�O�Z'6d�[/% IL%cG /��v<�ivE ,�E.Fic.�mo.vCE GuAa'.7�/�EE- O <br /> `SET•AS/,DE LETiE.c� FO.� S/pElddLK ALU�G' �'•F.'pNTAGE <br /> on/ S.r��.-.v AvE. � <br /> ,$ Td iS'E Co�✓ST.tcicTEo PE•e AP.o.PDl�E'O Plva:s C�aTE-D � <br /> 7-25` -8-�`�. <br /> G� A���/�/UT L!//LG Bl .t'ESPo,vs,sj�E FO.P �hE Cni✓S.-,ea�.-�oN � <br /> Gs� TifE SC«E,2 Tn TiflS BU/cDi�+/G /N !f�E EvE�JT a <br /> T E SEc✓E.t' /S NOT I�,s'TdCCc�'D dy THE ��L t�C.o [. <br /> jn�P•Pnt�En�F.�•T �DiST.c��CTH /L'ULtI /a� Pi2cYC*•c'ESS. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> less the Ciry of Everett from any and all claims for damages, cosis, <br /> __i�.—• ezpenses, or causes of action that may arise because ot installation <br /> � -�" _ �j �7 � �;_ �`�� and maintenance of Ihe improvement or other righbobway use hereto <br /> �� ��� - - � apnlied lor end lurther agrees to remove same upon notice Irom the <br /> Apuroved lor Con5lruction � - Date City and to replace public propertq damaged thereby. <br /> �"�� S ��� F� ( � � /� <br /> INAL INSPECTION Date _ <br /> Approved as Constructed Signa r�of Applicant ate <br /> PUBL�C WORK� OEPARTMENT WO K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett - 18 DAVS OF DATE PERMI7 IS ISSUED AND THERENF7ER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BY THE GTV U°ON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8815 PROJECT OVER 90 DAVS DURATION. <br />