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�� <br /> Appiicaticn For � <br /> � PI.JBLIC VIIO ' �� oa�e—��i� • l <br /> � p /��� �o� <br /> PUBLIC WORK RTMEPJT Public Wohs Permit p f`4 / <br /> 3200 Ce ar r e' A 1q 19g9 � <br /> Everett,WA 982 . 59�ry� J Builtling Permit N_ <br /> TYPEORPRINTONLY G�Pert�t SVV � <br /> ... . ................ .. ..E RETT r <br /> . �C85 Public Works Fee$2 J <br /> r <br /> ' Z3�z /36''� �C .r1✓ G�.,vr� � hi✓- g�'v3 7 Yt:) 7�z-d�5;�7 <br /> Ovmer Mailiny Address 7Cdy Zip Phone <br /> ��Yr.l� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Prcposed Work C��1✓ /l�0 ''�?^'f S� �/,vr3� /J,i c� _ � <br /> '�tvi Cr-+-tcG�1' I�n12 ��rZ I o �8�,/t� ,D�Lr> _c�df � Lo Z. � <br /> a <br /> PROJECT ADDRESS (if known) !!/O 'fZ„t(ST ,g.,,,,[_ `f 2:.� 3 C�r+:t c e✓"rA,.� � <br /> Attach four(4)copies ot plans for proposetl work-Draw to sca!e and note the following if applicable: � <br /> •PropeAy Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utililies � <br /> •Centerline of str^�t •Indicate No�!h •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE �-- � <br /> P[RMIT CONDIT!ONS: � <br /> 1.All calls;. -inspection shall be made 24 hours in advance - phone 259-8810. <br /> 2. All work shall be partormed in accordance with thi;permit and current City uf Everett Design and � <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8C0-424-5555. � <br /> �, Glerr� r�g shull bG da�u ti, � nt�tnn� �� w;ll �ot ����� � <br /> -�¢. ��J�� �wper�es� � <br /> Jr I n5-�I I 5; I� fc�tc� ��cwy �(�(MGLc�Y �ro��r I �J �is ��' �' <br /> Gi� �z.�c%vd � ZoSko.B �mc' i�►st�� l o�t..- 1eros;a•� ca� -b-�I <br /> l,� 5 Co���a� s rc8��Me ��.+ �s ��ru�� by -eke )��bl� c�brks <br /> �N5�lN40✓: <br /> �o, �Ce'v�J C!i� 5'�Gt,s G(E2✓1 G�-�, �i/ -�;wle S. <br /> '�I G('e��'nq f ay4� rJ�"J�'Yi q O✓J �/ — {7 U Lf OqL��/t.l o(J f CSiv'G �2XGt.at/t'C%N�1/ . <br /> J / J 1 � i � J <br /> ACK'�OWLEDGEMeNT OF CONDITIONS <br /> y� � � The undersigned ownedapplicant htreby agrees to hold and save harmless <br /> �r the City of Everett from any and all d.iims for da,nages,costs,expenses,or <br /> proved for Cp struc ion p e causes of action that may arise becarse ot installalion and maintenance of <br /> �/ / tneimprovementorotherrighbof;eayuseheretoappliedforandfurtheragrees <br /> // to remove same upon notice from the City and to replace public properly <br /> �'iLf«� —3 f�' damaged thereby. <br /> `FlNAL INSPECTION Date <br /> Appioved as Constructed <br /> � f <br /> �i ����� _ <br /> — SignaWru of Appiicar. D3te <br /> WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMff IS ISSUED AND THEREAF7ER IS TO BE DILIGENTLY PURSUED TC <br /> COMPLE710N.THIS PERMIT MAY BE CANCELLEC 2Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PpOJECT OVER 90 DAYS DURATION. <br /> .�..� 1 <br />