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i <br />' <br /> i <br /> �ate �L �/, R13 Pu�liclYoiksPermilx . �� <br /> C <br /> eiae�o�o�.� — <br /> Application For <br /> PUBLIC WQRKS PERMIT P��TaWfks�Fae $ � <br /> Less AOPI.Fee PaiE $ <br /> n»� <br /> Balence Oro $�r— <br /> Print or Type Only �� '� (�SSS3 <br /> �—n y s�.P-',JFC�hAFA.;`% C:e. f� bo:� //7i� Jr19�tl�GK'� �'�.�9 /�,C�/ �PhoneY.'C�-4�� <br /> � Mailing Address C��Y ZiP <br /> ��11-��E� Phone <br /> Applicant Mailing Addresa ���Y Z�P <br /> Describe Proposed Work <br /> /i,�tJ 1�����,r�-, CL�. <br /> W <br /> Prolect Atldress(if known) <br /> /s�' �c .-y �" <br /> � <br /> Attach tour(4)copies of �lans for proGosed work- Draw to scale and note the following as applicable: � <br /> • Propeny Lines • Centedine of street <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading chan9es <br /> • Exisling and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT COP7DITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. <br /> 2. All work shall be performed in accordance with this permit and wrrent City of Everett Design and Construction I <br /> Standa!ds and�pecifications � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> � ��.� i''�9r✓�S' ���.�sr�'o /o =.zs-d�� O , <br /> � ; <br /> � <br /> � <br /> . a <br /> � WLEDGE�dENT OF CONCITIONS <br /> The ndersig o ne applicant h agrees to hold and save harm- <br /> less he Cit E ere t fro an and a cla� s for damages, costs, <br /> � exp ses, o us.s o ac ion th �-may se he use ot installation <br /> �jU �� and ainte tt im rove e t th s right ot-way use hereto <br /> ap d f r n he gr t _r ov same up n nolice from ihe <br /> A ved tor Constructio � Date Cit �a d t c u c p m the <br /> C l -�.— 01 -/ y- � J x � .�'�_ <br /> FINAL INSPECTION ��te Dale <br /> Approved as Constructed Signature f Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceda�Street BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br /> Everett,WA 98201 CANCELLL-D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phon2: 259-8815 PROJECT OVER 90 D�YS DURATION. <br /> �_ _ <br />