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� ppplicatlon For / <br /> Pl36Ll WORKS PERMIT �18 8/�`� �1 - <br /> �CMr!� LIC WORKS DEPARTMENT Wblic Nbrks PertnN M ! � <br /> 3200 Cedar Sireet <br /> E tt,WA 98201 259-8810 <br /> Building Pertnk M__ <br /> TYPE OR PRINT ONL'f � � � Public Works Fee S � -�-�— <br /> zAk► k {-� � P��'l� N /o�2 � 7 IS (�1iu+ Sr �v2w� � q& ?�' 331f1944 <br /> Owner Maili\/k� �ity Zip Phone <br /> ��j✓YH.( Air �.ip�� ' <br /> Applicant Maili Address City Zip Phone <br /> P _�_Sec�.�5"-cea���_ � � � <br /> Describe Pro osed Work A.b h-,,a.�..� 0 1� O <br /> :-°'1 `� _�v� �ln,-� - G an r�r� 2 2 �O� � <br /> � <br /> PROJECT ADDRESS(if known) _ � � � � � S L � <br /> Attach four(4)copies of plans for proposed work-Drew to scale and note the iollowing it�:pplicable: m <br /> •Property Lines `Outline and dimensions of all existing an�!proposed structures on the lot •Existing and proposed utilities O <br /> 'Centerline of street •Indicate NoAh •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection s�all be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be pertormecl in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. � <br /> �� Jr���cw�y � > �x-�- sfd �-l'�h ��7 O <br /> a <br /> , <br /> , - <br /> - ��,Bo d� �-�-� � <br /> � ACKNOWLEDGEMENT C i'CONDITIONS <br /> n,� � Z 2 The undersigned owner/applicant hereby agrees ta hold and save hartnless <br /> �`/ d the City of Evarett trom any and all claims for damages,costs,expenaes,or <br /> Approve for Construction Date ceuses of action that may ariae because of InstalleHon end malntenance of <br /> the improvement a other right-of-wey use hereto applled forand 1uAMragrees <br /> ��� to rartwve same upon no[ce hom the City and to replace publb pioperty <br /> �. ' l�G�.n..-✓ 8-27-57 °e"'�a'"�reny <br /> FINAL INSPECTION Date <br /> Approved as Constn,cted � � <br /> C <br /> 519n re ot Applkant Date <br /> WORK AUTHORIZED BY THIS PERMR MUST BE STAflTED WITHIN 180 DAYS OF DATE P fT IS ISSUED AND THEREAFfEti IS TO BE OILK3ENILY PURSUED TO <br /> COMPLETION.THIS PERMR MAY 8E CANCELLED BY THE CfTV UPON ANY ST OF WORK ON TFiIS PRQIECT OVER 90 DAYS WflAT10N. <br />