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,�.,. . � <br /> � � �"^' <br /> �i. . _ � <br /> � � <br /> t <br /> . ..�„ <br /> . � <br /> � , I -- <br /> �a Date�z Public WoeAs Porm�l♦ 9� //`� <br /> A?plication For emg.oeni.• <br /> � PUBLIC WORK� PERMIT I Pu�hcWarksFee s <br /> ��` Toinl Fea <br /> HI Less Nop��Fea Peitl s a <br /> � <br /> !� � . � ' eaianco Due S 2� � <br /> Print or Type Only <br /> '° ��� �c�c�no �919 —�3� �+/e w , LS'v�.re,�#f 9�203 3�s 3-9.�' ' <br /> AOwner Mailing Address C�ty Zip Phone <br /> �rr [ au..�c�.,a�j�IGI - � ��tR ,�. �,�� 'sa�� �� 3v�o <br /> 1'�� � Applicant � Q Mailing Address Ciry Zip Phone <br /> f/ <br /> Descrihe Proposed Work �`�� ,'�J� Q�e�.'L�w� r� <br /> �� mti <br /> ` g� W <br /> .. __�. � <br /> Project Address(if known) <br /> 1 • Attach four(4)copies ol plans for proposed work• Draw to scale and note the following as applicable: � <br /> S+ - ''t' " . � � � ; • Property Lines • Cenlerline of street /A <br /> � � ' • Outline and dimensions ot all existing and • Indicate Nor�h V� �� <br /> � proposed structures on the lot • Show any proposed grading changes ,, <br /> . • Existing and proposed utilities • Stiow measurements <br /> `� DO NOT WRITE BELOW THIS LINE � I <br /> �� _ � O <br /> C PERMIT CONDITIONS I <br /> �, 1.All calls for inspection shall be made?4 hrs.in advance-phone 259•8810. q �� <br /> � � '<.All work shall be performed in accordaoce with this permit and wrrent City of Everett Design and Construction ♦ . <br /> � � ! Standard�and Specifications '� <br /> 3.Call Location Underground Service 48;vs.betore you dig.TOLL F,REE NUMBER 1•800�424=8555. � <br /> „ <br /> �� A� , <br /> � . -�'����;� ,���, � <br /> ' �� � �g � I <br /> � � ���� �� � � � <br /> I O <br /> .I �_I`i� IIU� h <br /> _ � � � <br /> � <br /> `�i�j�. <br /> ': �1 1 ;�tp�=p;!� � ; <br /> ` ���11`�1��''� ACKNOWLEDGEMENT OF CONDITIONS <br /> �, ^���1 �,..�� , � <br /> � �� •»`.��1 The undersigned owner/applicant herebv a�rees to hold and save harm- <br /> � I�i' less the City of Everett imm any and all claims for damages, costs, <br /> `�� expenses, or causes ol action fhat may arise because ot installation <br /> n and maintenance ol lhe improvemenl or other righPoLway use hereto <br /> -- � � 0��-- O3 �� applied lor and lurther agrees to remove same upon no�ice irom the <br /> Approv d tor C slructi � � a�e Ciry and to replace public propeny damaged ihereby. <br /> ` Lv'C ,� �-�'-� /�/J, /�J �/ <br /> � FINALINSPECTION Date,_- ��1/�^�U'�'��O "/-'?y_9.�i <br /> Approved as Constructed - � � Signature ol Applicant Date <br /> �ArI�� PUBLICWO(iKSDEPARTMEN WORK AUTHORI2ED EY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet / 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 6E <br /> Everett,Wf982 CANCELLED BY THE CITY UPOM ANY STOPPAGE OF WORK ON THIS <br /> ��ne:"259�8810 , PROJECT OVER 90 DAYS DURATiON. � <br /> / <br /> ;s � <br /> .___.__ <br />