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u .I <br /> Date q � y� ?5 PuCLc Works Perml�� � 1T� <br /> Application F T� p��j�N���-� Bt�g Jept.r r � <br /> FF. <br /> PUBLIC WORK� PERMIT PUOTotalFeeFee s �.73 — <br /> O LeS5AD0��Fee PaiE S <br /> 0 Balance Oue S � �� <br /> Print or Type Only r m m � 'r'- <br /> m �p N O C1 <br /> 1!1 IA N [� t'? <br /> M M # .-a <br /> �`('1��Iw g�vs InG I(��SmI� {�.�� SE <br /> Owner Mailino rase� r�. o- Cily Zip Pnone <br /> � ou� �+ c� � •• <br /> r� -+ .. � owc� <br /> Y.) O H '�. O :s W <br /> .� a a a a N U <br /> .�� <br /> Appli„ant Mailinq AddresS City Zip Phone <br /> Describe Proposed Work � n St?�1� ��1�V1 �'IC�B ��'1 ��-i�l /✓ `JE �\V 01�GX�5�/I �1 pl���S. W��C�ti1 <br /> � �J�� ��.Ul.✓ tit �i � �� �X�I '� 4 SoU'� i s � <br /> Iv�5t7�tI /lrla,mY 3� ' IJ�ui ✓r�a� �.M n 1 <br /> ��t�bc ee.sewi�.�t . Tc✓'�;��{- •� " c o <br /> � W <br /> Project Address�if known) ��7r I�'�"� �- � � <br /> Aflach four(4)copies ol plans for proposed work- Draw 'o scale antl note ihe following as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> D7 NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> t.All calis for(nspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Un�arground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O{c�t� <br /> �. 6�17 �.a�r► r�h�c�c� �wo-� 5 ka� �s I��Or�d ct-� G�fy �,,a,�1,��) � <br /> � h-� connu�ed -Ea rWc�✓ 5���✓ � ��r3 �A�_ <br /> �✓!ntG�i� D'{ .S�f�'� ✓�f�("r Y'G S T�"'v^' GX u�5 i rM o� $!i�✓ � <br /> v <br /> ✓� '� rh � � i <br /> 5 .�5 p�-✓ z��r°"`�.' f'l�, aNd�.��- as �r�� hy ;��-!�✓ O <br /> �� f� � a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City ot Everett Irom any and all claims for damages, costs, <br /> ezpenses, or cause: o` aclion that may arise because of instal�ation <br /> iA/1 ��_ .L/�/C,/j_ and m � enance of ihe improvement or other right-ot-way use hereto <br /> ��� � T applie for and iurther agrees to remove same upon notice trom the <br /> Approved tor st�uction �a�e City a �d to replace public property damaged thereby. <br /> i <br /> - 9 <br /> FINAL INSPEC71 D e <br /> Approved as Constructed nature ol Applicant Date <br /> PUBLIC WORKSDEPARTMENT W K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CodarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> r' Everett,WA 98201 BE DILIGENTLY PURSUEA TO COMPLETION.THIS PERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />