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Date 8 7 /� Pu�lic Wcrks Fnrmit r �j � <br /> ' Application For BI�B neo�.• <br /> PUBLIC WORK�, PERMIT PubTotaFaeFea $ <br /> Less AOVL Fee 7aiA .S <br /> Balanco Due $ 20 O� <br /> Print or Type Only <br /> C�FC�ew�G< /�, /�� 0 . l3X ��r<i�rco 9�27.5- r3-3isR <br /> Owner � Mai4ing Address City Ziu Phone �� <br /> s/}M E <br /> .4pplicant Mailing n. '��ss City Zip Phone ��, <br /> _�escribe Proposed Wor���4C� GUI D f S��e t✓.a �/� LJ%fit 5%d il�G!� Q �/UK✓�y ���. <br /> _ EiJ/Ydn/',r� Oev' � 3v7 dGf'd� � <br /> � <br /> � 09/i�519� �:ss��r� oae�ae�7, � <br /> �_ ProjectAddress(ifknown) 5�0 � — Z3 f}✓E.� N/� EY�'•fET7'i, (Yf} qd'i�r�ik2-.:3n_ � '. <br /> Att�ch four(4) copies of plans for proposed work- Draw to scale and note lhe following as applicable: ������` '�`�"0�' � <br /> • Property Lines • Centerline of street �y'`-�`� =��=�°=��=' � <br /> � Outline and dimensions o(all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> ' • Existing and proposed utilities • Show measurements � <br /> � DO �dOT WRITE BELOW THIS LINE � <br /> - PERMITCONDITIONS O <br /> 1.All ca�ls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction � �i <br /> - StandaidsandSpecifications. <br /> '., 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-4245555. � <br /> i' <br /> :1 CGX(� Tir� �L'u1�'J Qlfiw PpV2.s-,�.`y L�o7�.C/1GCE.'' O : <br /> !/ <br /> �. J�, ..S4uJ� C� � .sCphC MR/',fS O/^ /'ernOVC� � <br /> 7�a CX�aa.>s�on ,JOinf � � <br /> 6 �Mov� Concrcfe �v//er' cor++pCefC�ly �fbr� re/�our��� _ � I <br /> O �: <br /> � <br /> a � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby a^rees to hold and save harm- <br /> � less the City of Everetl from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because ol installation <br /> and maintenance of the improvement or other righFohway use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Appr ed for Co ctio � e City and to replace public property damaged thereby. <br /> ___-��1r=/C��G�'- /O -//-�/ � � 1 <br /> FINAL INSPECTION Date � � � 7 � <br /> Approved as Cer.,tructed Signeture of Applican Da e ��. <br /> PU��ilr WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAY� OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street �� <br /> Everett WA98201 BE DILIGE�'TLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS � <br /> Phone:259•8870 PROJECT OVI:R 90 DAYS DURATION. . <br /> . I <br /> i <br /> I: <br />