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� �y �; 9,, _ <br /> Date��U � Publ¢Works Permit n y7,c��— — <br /> o ApplicationFor emq.000�.r,_�� � � <br /> v <br /> PU�LIC WORKS PE�RMIT PubToalFeoFee $ /� �^f �S� <br /> J V <br /> � less Ao��Fea Poid S� <br /> � � N � � TO POSTING�.�-� Balancc Oue 5�s 6 <br /> Print or Type Only o o � .-� � o- <br /> o � mvi ,oa <br /> Mtl+ +-i .r � M <br /> 11-t1.1- stitit�i ` �l�G-s��'hte�.?T' P_o goy,��; C-vC�-V� °�?.Db ?�� 4�5� <br /> Owner .� a� +r ra c� m '�9 Address Cily Zip Phone <br /> i��- ���t�f\1.0 o d 3 � ",� Q'o�V�j • <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ����_L+.� Q'� C'�' � Q� � � � � ��'��`ti�� <br /> � {�, 1 <br /> �� � '_` � ,J1V � `n'� <br /> Prolecl Adtlress lif known) �7v �C�1 � `�� � � <br /> � <br /> Attach lour(4) copies ol plans fer proposed work- Drav�to scale and no�e Ihe lollowing as �pplicable: 0 <br /> O Property Lines • Centerline ot streel FA <br /> O Outlin=an� dimensions ol all existing and • Indicate North V�/ <br /> proposed sVuctures on the lot • Show any proposed grading changes <br /> � Eeisting and proposed ulihtie� • Show measurements � <br /> � � DO NOT WRITE BELOW THIS LINE <br /> PFRMIT CONDITIONS � <br /> 1.All calls for inspection shall 6e made 24 hrs.in advance-phone 259•881 G. � <br /> 2.All work shall be performed in accordance with this pennit and currei !City of Everett Design and Construclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> !� ��pn-e�-,o/or...lr�d /�/GH-s ��/,�'"� /-cg � 9/ � <br /> / � <br /> I <br /> Y/ <br /> 0 <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applican!hereby agrees lo hold and save harm- <br /> less the Ciry c' EvereU Irom any and all claims for damages, costs, <br /> i ���� eapenses, or ^.,uses of action that may arise because of installation <br /> �/ � � and maintenance ol the improvement or other right�of-way use hereto <br /> applied (or and further agrees to remove same upon notice trom the <br /> App ed for C st �h Date City and �o replac pnblic pro damaged thereby. <br /> i n <br /> ,�� /�'-3u- 9/ �� y I_ <br /> FINALINSPECTION Date ��P '�`"��- � �_"-� I <br /> Aoproved as Constructed Signature of Applicant Date <br />� WORK AUTi�URIZED BY THIS PERMIT MUST BL STARTED WITHIM <br /> everett PUBLICWORKSDEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND TF:EREAFTER IS TO <br /> 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> `� Phon���. �SD-U81r1 � ('�i�.li-CT OVGG n�l DAYS n11�1TION <br /> _ ., ,..,� . .- „v.. .�,... - �� <br /> �r �R " � �"+"`:�'"1 <br /> - >, , , <br /> .� _ <br /> � '�:. �"� _ � �t �.� s�".�., as�,�. � ..,�._�,,t+�"�`�w '� �#�'�- .. ,�+� <br />