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_ -- -r �. -, <br /> �Jr <br /> i <br /> � <br /> Uete`"�'�3 PubllfWarknPermit• $3 I 3 <br /> ApplicationFor e���.•�ec�. 3 O - <br />' �PUgLIC WORKS PERMIT PubTOWFeeFee s a o�� �— <br />� Lese AOG�Fee PaIA S � <br /> O�� <br /> ; Frint or Type Or,i;� I BalenceDue S �� <br /> 63��3 � <br />� (y.,un, s. F,�.o�s��. �1a29- lS'�A��N � S-��a�„�..�.a1 5'frz9a �/3S-y�.�3' II <br /> Owner Mailing Address City Zip Phone �'� <br /> S r��2� � <br /> Applic2nt Maiiing Address Ciry Zip Phone � <br />� � Describa Proposed Work 1 ^�� � '� �A�'^ 1 � �O�-t J'e• _ I� <br /> i <br />� _ W , <br /> Project Ad�ress(if known) � � � �-� � 5 S � '� <br />� Attach four(4)copies ot pians for proposed work• Draw to scale and note the following as apPlicabl=: � � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all exisling and • Indicate North <br />� proposed structures on the lot • Show any proposed greding changes <br /> • Existing end proposed utilities • Show measuremeMs /� �i <br /> W , <br /> DO NOT WRITE BELOW THIS LINE O � <br />� PERMIT CONDITIONS <br /> 1. All calis for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br />� 2. All work shall be performed in accordanc:with this permit and wrrent City of Everett Design and Construction <br />� . Standards and Specifications. 1 <br /> 3. Ca�l Location Undergraund Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � , <br /> 1• �CCSS �r �RrF�n� G..rta er �o� �W1�✓� P[��'n` M'[R � SNrs�t-/ Or <br />,I <br /> u..-p�`-�- � sl...e� 1� 10� o� wlle� • <br /> J V O <br />� � <br /> � <br /> O � <br />� <br /> a <br />� <br />� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownsr/applicant hereby agrees to hold and sava Farm- <br />� less lhe City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because ot Installation <br />� , 7 /����_ 6_�_F3 and maiMenance of the improvement or otber dght-of-wey use hereto <br />� %�s�� �� applied for and turther agrees to remove same upon nutice from the <br /> �p�ved it�tion� Date City and to rePlac^e PublJic Property dam2ged lherebY. .. <br />'�I f�-1G -�� . U — <br /> FINAL iNSPECTION Date � <br /> Aoprove�as Constructed Sigaature of F, plicant Dete <br /> WORK AUTHORIZEU BY THIS PERMIT MUST BE STP.RTED WITHIN � <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UP01�1 ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PAOJECT OVER 90 DAYS DURATION. <br /> !' <br /> i <br /> � <br /> C_— ^1 <br />