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� Pu�bc WorMs Peimd a _ <br /> �i - 9-�� <br /> Date�U'7 awe.000�.: ��— /1�G�1%.� — <br /> Applicalion For <br /> PUBLIC ViI�ORKS F'ERMIT PublicWortsFee S_ <br /> Total Feo <br /> less APpL Fee Paid S D <br /> Balanco Duo $ zo�� ' <br /> Print or iype Only /'A�p y/�.�7 S!/ <br /> '\ �`� s;�,�«� �r.� �azy�� G29-3:BS <br /> Uf,%f//.c� !�/l�eGt�[4/ ��ZU�o ���d� �/� Phone <br /> Owner <br /> Mailing Addre.,s ���Y ��P <br /> s',9/nE zi Phone <br /> qpplicant Mailing Address City P <br /> C'on/S�.eucT it/Ei� .SF.C�_.. — CG.�'.�•P J7"nm��J. <br /> Describe Proposed Work _ <br /> � <br /> /05�1� -io��' ./�.P SE Loi 3/ o{F•eE"vE,t � <br /> project Address(if known) �� <br /> Attach four(4)copies of plans tor proposed work• Draw to scale and note the (ollowing a, �pplicable: � <br /> O Property Lines . e Centerl�ne of st�eet <br /> • Inuicete North <br /> • Outline and dimensions of all existing ard � Shovr any proposed grading changes <br /> proposed structures on the lot s Sho�� measurements � <br /> • Exisling and proposed utilities <br /> DO NOT WRITE E�LOW THIS LINE � <br /> PERMIT CONUITIONS � <br /> " 1. All calls for insoection shall be made 24 hrs. in advance- phone 259-881 5. <br /> 2. All work shall be pertormed in accordance with this permil and current Ciry of Everett Design and Construction <br /> Standards and Specilicalions. � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•S00•424-5555. <br /> ,l� %f/� .�'�.��,�-�vivt%'i�'c, ��'c=� �c�;c%-'T�� O <br /> WiTjyiiJ i/�� �i �f��'.�c� v�'� �.. <br /> / f7�% ��`��J � <br /> �/GL�-t� //tl �r' !,�%�T.�i?/�---� � <br /> „— �'��:�T/c`y' O <br /> ��I�C��L G� /�jC'�C`.i �i5"G�TT//"�. <br /> _ �� �—� p. <br /> Cv�, ��1i,J �'%-� ,c -� - .. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save costs, <br /> less the Ciry of Everett Irom any and all claims tor damages, <br /> - � ., expenses, or causes ot action that may arise because of installatlon <br /> / � � and maintenance of the improvement or olher righDof-way use herelo <br /> �� � �%�i <br /> .X ���u` applied for and furiher ac�rees to remove same upon notice irom the <br /> qpp e�rCor tr tion � <br /> Dat City and to replace public properry damaged thereby. <br /> / � � �_ <br /> z 2 ��,-�����- �- ��i -�� <br /> FINAL IN�PECTIO Date �� Date <br /> Signature a t <br /> Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> cveret[ PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPF�GE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURAI�ION. <br />