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Date S.3/ l��y' <br />Application Fcr <br />PU�3LIC �di/ORiCS PERMIT <br />Print or Type Only <br />� v e �- •� %7� J�.! G(i <br />Owner <br />Applicant <br />Address <br />U `� <br />Malling Atltlfe55 <br />PuClic N'orhs Pormit a O 8 ��2S <br />Bl�p. OEpL • <br />PooLc warxa Feo <br />Totei Fce S <br />Less AppL Feo Paitl S <br />Ba:anceDue $ <br />�O o-.o <br />�e��e7`/ 9Y��•�' 3s'3-y7 4,6 <br />2ip pnone <br />� <br />Descri6e Proposed Work (�j � � �� � '>'t �� �/ C . <br />C�,�.g�zi�✓� � sr��r' � �t3w.r�. .�` i�/Lr �^��in�s' �,e <br />Project Address (if known) <br />'j � D tu � W /y" / 2� � ��Y �'e R'�� GCxrJc�E' ,C'iDG6 <br />Attach four (41 copies ot plans for proposed work - Draw to scale and n6te M�e lollowing as applicable: ,PoFU, <br />• Property Lines • C,enterline of stree� <br />• OWline and dimensions of all existing and • Ind�cate North <br />proposed slructures on Ihe lot • Shnw any proposed grading changes <br />• Existing and proposed u�ilities • Snow measurements <br />PF.RMIT CONDITIONS <br />1. All calls for inspectir,n shall be made 24 hrs. in advance - phone 259-8816. <br />2. All work shall be peAormed in accordance with this permit and wrrent City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underyround Service 45 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� ��',�P Sr.��s• CC��/ f/Y' %Cc Tiina�'J' <br />✓ %�GiCf.�T �%�S /�.�.P/�i// FO/�J /%i.¢ %�DLuTic <br />��r� f��� .l�Gi <br />evere[[� PUBLICWORKSDEPARTMENT <br />� 3200CedarSlreet ,,�,�..,...,�_„ <br />E���rett, WA 982J1 <br />Phone:259-8810 <br />�OS/31/ 6 2:57PM OOOR#OB33 <br />/ <br />H00010563 <br />PLN CH 3365.95 <br />�FT.20 520.00 <br />a0000esse <br />ELEC 825.00 <br />CHEC1; 4410.95 <br />ACKNOWLEDGEPAENT OF CONDITIONS <br />W <br />h <br />� <br />� <br />f"""' <br />V♦ <br />i� <br />a <br />The unde�� signed owner/applicant hereby agrees to hold and save harm- <br />less the City ot Everett from any and all claims for Uamag��.;, costs, <br />expenses, or causes of action that may arise because of i��stallation <br />and mamtenance of the improvement or other right-of-way ise hereto <br />applied for and furtf�er agrees to remove same upon noticc irom the <br />City a.nd to replace public property damaged thereby. <br />Signature of ApG�`-aN Date <br />WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DAIE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETIOt'J. THIS P[RMIT MAl' BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />