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<br /> Date�s 7 ����_�S 7 s
<br /> Vubllc Warks Pcrmn a
<br /> Application For Bitlp.Dept x 9,{�9 �
<br /> PUBLIC VV��KS PERMIY P°°�°W°�k=F��
<br /> TolalFce C--
<br /> Les.Appt Fee Paid S 7�
<br /> Print ar Type Onl i 8��,�=�o�e s "�L
<br /> RC CnnsfTuc� �c� (u . 111 SF G✓n�P7J� ' I ' ✓ �✓PiP/f' ��rLG•� 353-5>,�
<br /> Owner Mailin�Address !;ity � Zip Phone
<br /> Splicane Mailir.; �•!riress City Zip phone �
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<br /> Describe Proposed Work jl P m 1 S.�-. �� . — L N�� � � �-Cf:� E�:-n /,ii� �
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<br /> Project Address(if known) ��� '-i�'9��7`S/_' �
<br /> Attach four(4) copies o(plans lor propose��.vork- Draw fo scale and note the following as applicable: �
<br /> • Property Lines • Centerline of street �
<br /> • Outline and dimensions of all existing and • Indicate North
<br /> proposed structures on the lot • Show any proposed 9radinc� changes
<br /> • Existing and proposed utiliiies o Show measurements �
<br /> DC NOT WRITE BELOW 7HIS LINE
<br /> PERMIT CONDITIONS �
<br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. �
<br /> 2. All work shall be performed in accoidance with this perrc�it and currem City of Everett Desi�n and Con,truction
<br /> Standards and Specifications.
<br /> , g you dig TOLL FREE NUM9ER �•800•424-5555. �
<br /> 3. Call Location Under round Seryice 48 hrs. t�efore
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<br /> f•!Y I_OT C-i!'"il.iDF Ci-li?�IG�.S I°iU'=:T E�4= �1P'F`I. �
<br /> _ ,JF:LIC IrlOfifi� Ii',ISF�_r fi�R. �
<br /> S`['f-'' !_';TY �l"I'',EE:"fi f;!_Ftl�4 !'vT ^!_I... ?� �
<br /> ,��T(-;l..L plflTrF: EsC1XP:< "f;J GI;AIiL (-� f �
<br /> �,UR_E �)F P.�E'IJAYS AF•�� �,�n,�ni E-" f=LV f,i li �_�, �,�:�.;
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<br /> ACKNOWLEDGEMENT OF CONDITIONS
<br /> The undersigned owner/applicanl hereby ac�rees to hold and save harm�
<br /> -- less the City ol Everett from any and all claims for damages, costs,
<br /> `/ expenses, or causes of action th:.t may arlse because ot installation
<br /> �,%�1 /������r�:_ q/��/�� and maintenance o( the improvement or other righ�-of-way use nareto
<br /> Yr" �` applied for and further a�rees to remove same upon notice from tne
<br /> Appro�ed for Cons ruction , Date City�and to replace public p operry da�naged ihereby.
<br /> � � l/ �� , � ��' :��:�/�-_ , ,�C C .z;���uo2��n C�r�fe�tau�
<br /> �L --�� � s:�� l�� ,r <� � % , 3_ > > _-',S�'
<br /> FINAL INSPECTION � Date LL �ll-� ��.1. �-��
<br /> Approved as Constructed Signa ure o�Aprh licon� Date
<br /> everett PUBLIC WORKa D[PARTMENT WOPK AUTHORIZED BY THIS PERMIT MUS7 BE STAqTED WITHIN
<br /> � 3200 Cedar Slreet 180 DAYS OF Di�� 'E PERMIT IS ISSUED AND THEREAFTEP IS TO
<br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE
<br /> Phone: 255-8815 CANCELLED f3Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS
<br /> PROJF_CT O\/ER �0 DAYS DURi1TION.
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