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r. . <br /> ��y w <br /> Q � - <br /> ,�,�pH�V� <br /> Hx� <br /> 1i O <br /> �y O <br /> y(�A H Date�U . ,_,;� r-•::. wmi��wo�w:va,mp�i. q _ <br /> � '2('�1� Ppplication Far oiao oeo��+—.,cQ'�.X�� <br /> 'J d Pu06c WO�ks Fee <br /> � �g PUBLIC WORKS PERMIT ,o,,,F�� $ <br /> �y � �essPoO��FeePai� $ <br /> 9 y� Print or Type Only ar���«o�e s <br /> r� <br /> g�y + ) n <br /> o ��/+ /71�ia1�P�/ (D,-v /L�i,y,,hN �i1���G,�;� � [��t11r:�LLh�1�?M, r,,,,4 /��h1�1-e/,�- <br /> �� Owner Mailing Ad ress Cuy Zi Phone <br /> oy _ C?�c,,r��� )�dP (D'airiH�� � �`r -/GQT'`l�r� �F , ��/li�vi�-<— 9�R' G �/-d�J <br /> --- - -- Appucan� Mailing Address City Zip Phone <br /> � � Descn9e Proposed Work �'�P��n� �M�(D�Pt2l� L� _ <br /> Prolecl Address lif known) L� �v� ^ I �t��"L J� C��J�:(�� � . <br /> � <br /> Attach four(a) copies of plans lor proposed work� Draw to scale and note the following as applicable: � I <br /> • Properry Lines • Centedine ot street �. <br /> • Oulline and dimensions ot all ezisting and • Indicate North I <br /> proposed structures on the lot • Show any proposed gradin9 changes � <br /> � • Existing antl proposed utilities • Show measurements � I <br /> ' 1 DO NOT WRITE BELOW THIS LINE � <br /> '�' PEFMIT CONDITIONS O . <br /> '�1 1.All calls for inspection shall he made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in acwrdance with this permit and current City o(Everett Design and Consiruction <br /> 1 ' Standards anC Specilications. <br /> � 3.Call Loca�ion Underground Service 48 hrs.betore you tlig.TOLL FREE NUMBER 1•$00•424•5555. � � <br /> I <br /> � �� �L�� � ���� O <br /> I � G�/� � c� � <br /> � <br /> i a ' <br /> 1�' ACKIJ(1WLEDGEMENT OF CONDITIONS <br /> . _ The undersigned owneVapplicaN hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims lor damages, cosis. <br /> expenses, or causcs of aciion Ihat may arise because ol mslallation <br /> and maintenance ol the improvement or other righbol-way use hereto <br /> applied for and f�rther a9rees to remove same upon notice Irom the <br /> Approved for Conslruction Date City and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date � <br /> Approved as Construcled Signature ol 'lpplicant Date <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUl'HOfiIZED f1Y THIS PERMIT tv1U5T BE STARTED WITHIN <br /> 0 3200CedarStreel 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.TNIS PERMIT MAY BE <br /> Phone:259�8010 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />