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nate wex�www....mn. `lfU <br /> Appllcetion Fo� ��'^�• <br /> PUBLIC WORKS PERIIAIT P��WO�F� <br /> rau v,. • <br /> Lso�ppL Fee P�id a <br /> Print or Type Only <br /> B�4nu Dua S �— <br /> 1�1,aQ,leu �Ctanle.z '3719 /a� '"� ST, S„� t-vc�e� , �v,� 9b.�d� 33�-o3zs- <br /> Owner � MaiPng Address Cily Zip Phone � <br /> 5,q�r� <br /> Applicant Mailmg Adtlress Cdy Z�p Phone <br /> Describe Proposed Work � a ,�7�ti5 �C, �J/� /f y, y �L_ j��j� — (v�5( �SO � 7 <br /> Project Address(it known) la 4 o K � 9�� /-�fi,f� �L.✓�.e�« � <br /> Attach four(4)copies o(plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine of street � <br /> • Outline and dimensions of all existing and • Indicale North <br /> proposed siructures on the lot • Show any proposed grading chenges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for mspectbn ahall ba made 24 hrs.in advance-phone 259�8810. � <br /> 2.All work shall be peAormed in eccordence with thia permit and current City of Everett Design end Conetruction <br /> Standarda and Specifications. <br /> 3.Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1-800�4245555. � <br /> <}• `'.-�►- �n..� � � ,� �//� � -s--9 S' 0 <br /> �'i"..,"F, __ j•5���` Jftf?:H.^.��� � <br /> ' % <br /> a�'00°5�6� O <br /> �I�'fR 37�.J� <br /> 77�E�,R. 210Q.",'�' � <br /> CHE��' �1.75.3? <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> undarsigned owner/applicant hereby aprees to hold and save harm- <br /> less the City of Everett from eny and all cleims lor Aamepe0. costs, <br />, ezpenoes, or causes of action that may erise becauss of Installation <br /> and maintenence of the improvement or other ripht-of•way use hereto <br /> applied for and further agrees to remove seme upon notice from the <br /> A ed f c ion Da -. City and to replace public property damaped thereby. <br /> �„ .�el � z - Zs�iS' � / � / 9-�3-�' <br /> FINAL INSPECTION Date ��A,n/�p�y� �C/.H.�D�I 7i� <br /> Approved as Constructed Signatw�of Applicant D�te <br /> PUBLIC WORKS DEPARTMENT WORK AUTNORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> 3200Cada�Slreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER I$ TO <br /> Everett,WA 9820t BE DII.IQENTLY PURSUED TO COMPLETION.THIS PEpMIT MAY BE <br /> Phone:259•8810 CANCELIED BY THE CITY UPON ANY STOPPAOE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUMTION. <br />