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:.�. - :::::..--,�-�'"'-- <br /> .... .___�_. <br /> /O Q� � Pu�IlcWorkaParmitA �+"�_ �v� <br /> Date � <br /> eia4.oeo�.• <br /> Application For <br /> PIJBLIC WORKS PERMIT '"'TOWFaaPeB s <br /> Less ACD�Fee PaiE s <br /> ea�a��ao�e s ND C'y.9.�GE <br /> Print or Type Only <br /> ✓A/i� S C� �C l/��[.l1.Y/l�F—J[ Z� Phone <br /> Owner Mailing Address ���Y P <br /> 2'7v9 �s� st �uf,�l��,��A Pho�s� -oybl <br /> Applicant �/ / ����/ <br /> Mailing Address C�ly Z�p <br /> Descri6e Proposed Work � / _ � � <br /> �U! /I' nriC/� �./�f �✓H��`+ �i'IC! S"i19fl�/ GGY�T1/ <br /> i o n n ia {�7 �RLJ/� � T!i r' � /?F G) �C/1C� //7 .fJ/9C:.bs <br /> W <br /> Prolect Address(if known) ��09� ZS �S7`" � <br /> � <br /> Atlach four(4)copies of plans tor proposed work-Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> � Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be m�Cc 'eN hrs. in advance-phone 259•881 5. <br /> 2. All work shall be perf�rn�ea in accordance with this permit and current Clty of Everett Design and Construction <br /> Standa�C�and Specifications. � <br /> � ;,. �all Lccation Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•S00•424•5555. <br /> �S'.�/ou�d T.rl6 Cir1/ oF Ec�E�E'T�'" I�Eat�o� To O <br /> �EvFGo�E T,r/E STizEE T O� AL L 6y �9T f�Ny H <br /> Tir�E /•d Tf/E `c`rli.e E , %//E DuJn/E2 OF THis � <br /> /�OUSE G+�iL L B� ,�'EGj Ur.eEO %D .eE�rloliE A•�/�/ O <br /> �H•CT 0� 7�f��' ,8.e/C,C Si�E��AG/C O.e LcJALG � <br /> TyRT WoU�� D.BSr�vci' SF�iO ,r�Ed6�oP�C�✓T, <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � �esc the City ol Everett from any and all claims tor damages, costs, <br /> expenses, or causes of action that mey arise because of installation <br /> �_.'���`"' O�'' 7// anL maintenance of thr. improvement or other right•ot-waY use hereto <br /> B7 / �� �'e applied for and further =grees to remove same on notice Irom lhe <br /> � Approved for Co r cLon Date City and to replace public properlY damaged th eby. <br /> r {q(F' �O'G�L ,� l <br /> FINAL TION D2te Oate <br /> Signat e ot Applicant <br /> qpprov d as Construct y�/ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT ;q0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet 8E DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />