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�� <br /> _ .. .. . <br /> � . _ � _ -.:, , , <br /> ,,, � , . <br /> ,;�oece ���� , -7/ <br /> Pwlie Worka Perml�♦ <br /> � Application For eiao.oeP�.r.� <br /> ,: <br /> f'UE�LlC WORKS pERMIT PubIICWorksFee — <br /> �a�e�Faa s <br /> Laea AppL Fee PaiO S_ <br /> Print or Type Only eem��ao�a S Z� <br /> � � L-k, Gli� �d �_ s t_ S HoH. �✓q_ s� � 33 y-7G0�' <br /> Owner Mai4ing Address Cit <br /> Y Z�P Phone <br /> 1'v�o w� i' s - Nc. SNo ,��misr-�� l�✓r�. 9u��0 334 -��bU � <br /> Applicant ai�ing Address Cdy Zip Phone � <br /> DescribeProposed Work —� /N �Lk Yam�Ly �S �� ���', � <br /> �. ,f,:_E �;_-.� � UJ ;I <br /> a'�i� a� ' � <br /> Project Address(if known) — '� s'F " S� �o� j , . E � � <br /> i <br /> Att �h f��ur(4)copies of plans tor proposed work- Draw to scale - note the tollowing as 3pplicable: � <br /> � i• Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North �� <br /> proposed structures on ihe lot . • Show any proposed giading changes � i <br /> � Existing and proposed utilities • Show mee>uremenis � � <br /> DO NOT WRITE 3ELOW THIS LINE ��. <br /> PERMITCONDITIONS �, I, <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259-8815. � �. <br /> 2. All work shall be partormed in accordance with this permit �vd current City of Evereh Design and Construction � <br /> Standards and Specificationa <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � J ioE- GiF�c.�' G'vF'�d � Z <br /> i �� C�vl7Ei2 ,��.c/�.:<J �' Gln/6',E�o,�`E�/ O <br />' f�'vy A9�:_.:^rE Sis;9tt o^E .PE'yAGEo ,6'y Ti�E- s9f%�LiCsJ�✓%• <br /> .S Lti'STf�GG. d.F'�/CdEGG F.� .dOw.rJSPcvTS F,�S NO%c�',�7 � <br /> Gv✓ Pl.oT PCi9,u , <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENTOFCONDITIONS � <br /> The undersigned owner/applicant hereby agrees tc hold and save harm• <br /> less the City of Everett from any and all claims for damages, costs, <br /> �� ���� . �� � expenses, or causes of action that may arise because of installation <br /> �� /�j� � �� � and maintenance of the improvement or other right-of-way use hereto <br /> Approved for Const u 'on lied for and uriher ag�ees to remove same upon notice from the <br /> �� ' ate Ci: and I public property damaged ibzreby. <br /> � 3 � l � Fz3 � g(� <br /> FINAL INSPECTION Date 0� <br /> Approved as Constructe! Signature o H,:plicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST ;iE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE Pt.3M1T IS ISSUED AND 1nEREAFTER IS TO <br /> Everett,WA 9tS201 BE DiLIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Pho�ie:259•8l315 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK pN T!iIS <br /> PROJECT OVER 90 DAYS CURATION. <br />