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i <br /> � <br /> I <br /> i <br /> Date��^ -�- 8 zs� <br /> Puplic Woiks Permi�• <br /> Application For em9 oaoc+_ � <br /> PUBLIC 1�91/ORKS PERMIT PubLCWorkSFee — I <br /> Tolal Fee �— <br /> Less ADP��Fee Paitl S O� <br /> $ I <br /> Balance Oi�e <br /> Print or Type Only <br /> � ��rfi��, � ���-����> /1rr��n ��,� i�r�-C���r���.l ���'� �ac� j <br /> Owner Mai{ing Address Ciry Zip Phone I <br /> � <br /> ;5;9J,/Y� I <br /> Applicant Mailing Address City 2ip Phone � <br /> Describe Proposed Work I t'/��� I ll ��C`X, —. . I <br /> _.._. I <br /> I <br /> 2�0 - W I <br /> Pro�ect Address(if known) 3 9�d � ��P �s� � � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the t�llowing as �pplicable: � �� <br /> • Property Lines • Centerline of streel � � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> . proposed suuctures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show n•:easurements � � <br /> DO NOT WRITE BELOW THIS �INE j <br /> PERMITCONDITIONS O I <br /> 1.All calls for inspection shall be ma�e 24 nrs.in advance-phone 259•S�i 0. � ' <br /> 2.All work shall be performed ir�accordance with this permit and current City of Everett Design and Construction i <br /> Standards and Specifications �, <br /> � 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$OQ•424-5555. � �'� <br /> O <br /> � � <br /> � II <br /> � <br /> a <br /> � <br /> ��Fy ACKNOWLEDGEMENT OF CONDITIONS � <br /> ` The uncersigned owner/applicanl hereby agrees to hold and sa.:•;���im- <br /> — less the City of Everett Irom any and all claims for damac���,, :,c;ts. <br /> ��„ �� expen:;es, or causes of action ihat may arise because ot in5lallalion <br /> /i/ 08 and maintei.:: .ce of the improvemenl or other righPot�way use hereto <br /> � U applied for a.id turlher agrees tu remuve same upon notice Irom the <br /> Approved lor Cons ction ate City and to replace pu6l/ic�property damaged thereby. . <br /> G / S�}� ��if'� � l�t�w�./�--�' C� ^Z / — b � I <br /> FINAL INSPECTION �ate . <br /> Approved as Constructed Signature ot Applicant Date <br /> WORK AUTI-IORIZED BY THIS PERMIT MUST BE STARTED WITHI�I <br /> everett PUBLIC WORKS UEA.4R7MEN7 180 DAYS OF DATE PERMIT IS ISSUED AND ?HEFEAFTER IS TO ' <br /> � 3200 Cedar Strc�:t BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 982)I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�887t� PROJECT OVER 90 DAYS DUFATION. <br /> I <br /> ' I <br /> � <br /> i <br /> �, <br />