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�, Pu�bc Woiks Permlt• <br /> 8'� �t <br /> Date� � BItlB OcOt.s--- <br /> qpplication For -- � <br /> �o��� �,�ap,{�■ �� Pu�licWorksFae S ��,� <br /> P U B L I C �:��i�� Toiel Fee <br /> Less ADot Fea Paia g�— <br /> Balance Oue <br /> $ �LCa•� <br /> Print or Type Only 6 f 6 `�� <br /> S� A 'upw1Z � PACIr`!� PJ, W, � i'�F', 13�9 �i4r� Ztl S.E , '�3LP e4ssC is �?r <br /> Owner Mailing Address ' <br /> S ^'- _— "—_—C,ty Zip Phone '_.— <br /> qpplicant Mailing Atldress <br /> Describe Proposed Work �� r `��� �~ �S � n C N L E� T �—� — <br /> .�r <br /> _.— � <br /> -- � /o G a �- /p � 7>, S c � <br /> Project Address(if known � <br /> A t t a c h f o u r(4)co pies of plans tor proposeo work- Draw to scale and note�Cen�'erl i n e o f s iPP e t able: � <br /> • property Lines � Indicate North <br /> • Outline and dimensions ot all existing and p Show any propo�aed grading changes ���aaaAAA''' <br /> proposed structures on the lot � Show measurements � . <br /> • Existing and proposed utilities �.� <br /> DO NOT 1�JRITE BELOW THIS LINE � <br /> PER�dIT CONDITIONS �1 <br /> 1. Ail calls(or inspection shall he made 24 hrs. in advance- phone 259-881 5. <br /> 2. All work shall be pertorrned in ac cordance with this permil and curent City of Eve:ett Design and Gonsir��:�ion �� � <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 h�e. belore you dig.TOLL FREE NUMBER 1-800•424-5555. � Y <br /> ��. <br /> � C. <br /> �S � � <br /> � .� <br /> r; .- <br /> � � ; <br /> I � a ` <br /> 4�.� � : <br /> N F <br /> ['] � <br /> � <br /> b : <br /> l+CKNOVJLEDGE61ENT t �ONDITIONS � , <br /> The undersigned cwner/ap?IicaN haret agrees to hold and save harm- �� <br /> less the City ot EvereU from any and dll claims lor damages, costs, � �'. <br /> //' expenses, or causes of action lhat may arise because of installation � f� <br /> ,�- // and maintenance of the improvement or nther righhob xay use herelo ,� : <br /> �`/Gf�' � /�^ f � aPPlied for and further a9rees to remove same uPon notice from the <br /> ,��IS/ Date <br /> hpproved jar,Constiuction C i t y and to rePlace pu6lic property damaged thereby. ~, <br /> / ' � <br /> Z-l �-8�� "3 - 13 -F?t�- n . <br /> Date � C � �� Date '^ <br /> FINAL I PECTI Signature o�Applicant � ,. <br /> qpprovedasConstructed WORK AUTHORIZED BY�THIS PERMIT MUST BE STAR�TED WITHIN <br /> eve�ett PUBLiC WORI<S �PARTM T 180 DAYS OF DAfE PERMIT IS ISSUED AND THEFEAFTER IS TO , <br /> 3200 Cedar Strr BE DILIGENTLY P�9SUED TO CO�v1PLEi-ION. THIS PEH�.41T M11AY BE <br /> � G��,ret1,y�rq ggpp CANCELLED BY THE CITY UPON ANY STOPPAGE OF VJOR✓.ON THIS <br /> � Phone: ?59-8815 PFOJ[CT OJFR 50 C AYS DURATION. <br />