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� —_ .� <br /> . <br /> Date �, / S Publi�Work;Pcrmi�= G?�"��v <br /> Applica�ion For emq.oeoi.-_�S� <br /> P�lBL1� WORKa PERMIT Pu�TolalFeaFep S <br /> �ess anoi.Fee aa��e S_ <br /> Print or Type Only B��a�=�o�a s ��-DO <br /> ;_� � �Sa�, ., �9� 3 3 <br /> ��'� - nn /��/ �j�'✓�/�Ii/1�' ��u�/ l' �/Ni�� �' / �� �� :'>� `/-ic <br /> � Mailin Address , �� / /� // / <br /> wner g City ZiU Phone <br /> �0�'1� ( p1�� ,� � � ; .(% <br /> Applicant Mailing Address Cil <br /> Y ZiP Phone <br /> � i <br /> � � � <br /> Describe Proposed Work �- �-� r���,I' � �{T.J L�(. � '.��L��/Yr� ��lj- ,�i �-�'.-A� <br /> — . /n�is - i�-� i?�sE � <br /> �-� iti � '/ n I- <br /> Prolect Address lif knowN � -� - -�it- 1 G� �iV X /��� !/L �C CYCi:c'' <br /> Attach lour(4) copies of plans for pruposed work- Draw to scale and note ihe following as applicable: v <br /> � Property Lines • Centerline of stree! � <br /> • Outline and aimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exis�ing and proposed utilities • Show measureme�ts � <br /> DO NOT WRITE BELOW THIS LINE /� <br /> PERMIT CONDITIONS V <br /> 7. All calls tor inspection shall be made 24 hrs. in advsnce- phone 259•861 5. � <br /> 2. All work shall be performed in accordance with this permil and cw�ent City of Everelt Desi9n and Construction <br /> Standards and Specifications. <br /> 3. Call location Underground Service 48 hrs. before you dig.TOLL�PEE NUMBER 1•SOU•424-5555. � <br /> �. L� F/G'G �rvT�2i,crG /5 To 'dE .eEr�CvE� <br /> DD NOT PG.QGF /ir/ Ap.,j,�GE/r/T ,� <br /> �) �i�l • � <br /> oc , 1i�1�l�L �1�,r/fr�/ ,J,eGt�.At//G �1�Id iE',c�i�{ C . ''�' <br /> / <br /> .3 Ct�.tlr�lECT .C�Opf` l�Occl�JS,Pp�j� /�dTo A�a,eo�F..o � <br /> STo,�rn Lc.1aTE.0 S�/Si�..�r�� /UoT /NTO C,eEE,C .d2FA. � <br /> � a <br /> 4� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City ol Everett trom an, and all r.laims for damages, costs, <br /> � �J„ expenses, or causes of action that may arise because of installation <br />� � ����� and maintenanca ol the improvemenl or other righbol�way use here�o <br /> applied tor and Iwther agrees to remove same upon notice from the <br />� Approvetl for ruction Date <br /> , Cily and�' replace public property damaged ihereby. <br />� �_ Z-�L�3f3 �.- -�� ,/� �/ <br />� FINAL� S ECTION Date l ` / � � 2C�-(_�r,-� �—� �C:-�7 <br /> Approved as Construc ed gnature of Applicant Date <br />� ev�� PUBLIC WORKS DEPARTMENT WORK AUTHORiLED BY THIS PERMIT M11UST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER !S TC <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. iHIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STGPPAGF OF WORK ON THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br />