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Date S � y �y <br />Appiication For <br />PUBLIC WORQ(S PERMIT <br />Print or Type Only <br />�J At-'A l.- <br />owner <br />Describe Proposed Work <br />Pro�ect Address (if known) <br />Sv iS/ <br />Pu�lic Works Pe�mil • <br />BIEp. Dapt i <br />Pu�lic Works Fee s /��3� p(p <br />To���Fea � <br />Lena Appt Fea Pe�E S <br />Balance Oue s <br />/�/j o0 <br />�l'�Z2 52'n,C'PS �-v�t'� 9�,Zo3 <br />Address <br />c+cv <br />cny <br />th f II win as applicable: <br />Attach four (4) copies of pians for proposed work - Draw to scale and note • Centerline of strael <br />• Property Lines O Ir�dicate North <br />• Outline and dimensions ol all existing and � Show any proposed grading changes <br />proposed struclures on lhe lol � Show measurements <br />• Existing and proPosed utilities <br />(,ti3- `/3no <br />35'3 25S <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be peAormed in accordanse with this permit and current City of Everetl DesiS�� and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FHEE NUMBER 1•800•424•5555. <br />�/ _-� -�-V, Z `-� �� ..-� d f c:. -� c�: I I ct P S c' S C�. ��� re s �. I} c r � t S <br />�� �I �t-�-� �� I,. �...k sL.�.i� br r��.�•�.•- � 61e <�� <br />ITs c c� n� r °",�/o� ��.� l ac �.,.� r..��-- <br />�✓Osio.'. G..,c�l'Yc�/ ryG'C1// bi /rr.iPr:/�Nc,l� 4S �i/f'cfr / <br />e.� -4-I�. P��i,� �ti��.�� sk.�,���1ti,-, <br />� � ��h,-;s �,�.�> ;— � � 1< <� �- Fv� �� �,-� ���,�� <br />�,� �,-s <br />((Ati�' Oe� �o <br />9. ��'S�I,,.,� ��� r<�, � <br />/Jr oY � _ f s. <br />W <br />H <br />� <br />� <br />z <br />C� <br />�-� �Oc �.,� «7 <br />y�7�. ��,�> o e�a � PCKNOWLEDGEMENT OF CONDITIONS <br />/ ;P' J�/- <br />��H 7'�c / Co rl'7�a under; igned owneUapplicant hereby agrees lo hold and save h2rm� <br />less the City of Everett from any and all claims tor damages. costs, <br />, � expens^s, or causes ol action that may arise because of installation <br />/ and maiMunance ot the improvemeN or olher right-ol-way use hereto <br />��� ��✓L� ��'d���y ap�}ied foi and turther agrees to,remove same upon notice Irom the <br />Approve siruction � Date CitJ and to rePlace pu6lic propert� damaged ihereby. <br />�/����-�-- ,- � - � -�- - <br />FINAL�INSFECT�O�`1 -� / 1 � / / D'etB <br />�CG'rs7�„c� o., -�o. �c`Y«/ <br />everett PUBLIC WORKS DEPARTMEfJT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259�887 5 <br />3iq ature of ApP��Qem <br />JJG K AUTHORRED 8Y THIS P MI <br />180 DAYS OF CATE PERMIT IS ISSI <br />BE DILIGENTLY PURSUED TO COMP <br />GANCELLED BY THE CITY UPON ANY <br />PROJECT OVER 50 DAYS DURATION. <br />IE STARTED WITHIN <br />THEFlEAFTER IS TO <br />HIS PENMIT MAY BE <br />E OF WORK ON THIS <br />H '�7 <br />H �- <br />� �: <br />�� <br />�y k' <br />L+l ~ <br />C.^ <br />~ f <br />Ot <br />.j r' <br />�C <br />�E <br />H( <br />