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'a <br /> , <br /> Date �� � �.5� 8S- �35s1 <br /> - Public Works Permi�K _ <br /> AppliCation For � Biop.occc.s�7 /D. _ <br /> PUBLIC WORi�S PERMIT PU�Tate'FeeFre g <br /> Lnss ApN-Feo PaiO 5__ <br /> Print or Type Only BalanceDuo S Z�G�' <br /> /� /� ��,�-.3�35 <br /> �1P11 ,3�� ��=��f f Mdll l �aC�� SUITP / �i/Oro � �/aD <br /> Ov.nsr Mailinc�Address Cd J� � 9 <br /> Y Z�P �hone � i <br /> --�-d YYI� <br /> Applicant Mailing qddress Cit <br /> Y ZiP Phone <br /> Describe Proposed Woik <br /> `OT 27 ' ( ' <br /> � � —LD_l��/D� J r � FI/PYP7`7� 9��0 �%� E�Ee �� <br /> Project Address if known � <br /> Atisch tour(4)copies cf ptans for proposed work- Draw to scale and nofe the following as applicable: <br /> � • Property Linea o <br /> • Centerlina of streel I_ <br /> • Outline�nd dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes � <br /> • Existiny and proposed utilities • Show measurements <br /> �� M <br /> DO N07 WRITE EELOW THIS LINE W <br /> PEFlMIT CONDITIONS � <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•881 5. <br /> 2. All work shall be perlormed in accordance with this permit and current City of Everett Design and Construct�on � <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. bafoie you dig. TOLL FREE NUMBER 1-$00•424-5555. <br /> �/, .e'a�F �of' .D.C'�.ive�.E /S 7'0 6F TiG�/r_ l��vEG TG� � <br /> �j �'t'"S�<>�.✓iieL So<<✓�[.: V.��oi.L_ TO Bc� fon/S".-.�'a�TEO O <br /> f�.c' ��%Tl/ SiG�vO[If_',O � 3/� <iiAGHEJ� <br /> .S, v,��',v�c vr �- s,oE c.�o�,C ,a,PE u,d.l�,�o,c-E,U, �/Al% aF s.�i.�� � <br /> l�i1i�'JAIf�-�G s'f.�4CC t�E ��E.�-'[�fC�� .�y %//E /.',/�i�CifAn/r � <br /> lo. �•Uj l�•C��i:r/� �F Ti/iS Lai �S To 6'� 1.L�'JE Sv A-� NOT � <br /> �(� rnli�QC�J /Hf ��JGiii//ii/C GUrS Gt//%f� /i4ii(/'Cc(diE� ��UrriUr`j,l ^^ <br /> r L n.'S:A CC A Sar�Z�LE CL Ed.11GlJT �2 TiY_ SiOE SEsJG��C,' /f � <br /> !T fjjCG.S- /.11 �Ui2//'EF✓t7� f�E.E' C�TY ST.ean/O.O�:L� ��'��� <�.r.�IGN.=t� <br /> / <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> — The unders�3ned ewneqapplican[hereby agrees to hold and save iie�rm- <br /> less the Ciry of Evere�l Irom any and all Gaims lor damages, cosis. <br /> expenses, or causes of ac!ion chat may arise because ot installation <br /> u� and maiNenance of the improvement or other riqhbof�way use hereto <br /> Approved f6rCon trudio���-jL—��/��� aPP�ied for and further agrees t� remove same upon notice frov� the <br /> i Date City and to�eplace public proparcy damaged ihereb;�. <br /> l,�l.Jc,' /1i 10,. / , . <br /> FINALINSPECTION ��� � Dat�G cvU� .�//3//�� <br /> Approved as Constructed Signature of Applicant Date <br /> everc[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireel iB0 DAYS OF DATE PERMIT IS iSSUED AND THEREAFTER IS TO <br /> Everett, V/A g8201 BE DILIGENTLY PURSUED TO CO'v1PLETION. THIS PERMIT MAY BE <br /> Phone:259�8815 CANCELLED BY THE GTY UpON nIJY STOPPAGE OF�^!ORK ON iHIS <br /> PROJEC7 OVER 90 DAYS UURATION <br />