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(' ��i <br /> � <br /> I <br /> � 4� <br /> � vV <br /> i . ''i.}� <br /> I !'7 <br /> I <br /> i <br /> /I <br /> Date1� /• �/���"' Public Woiks Pormil q �� �� <br /> �� l <br /> l,pplication For BItl9 DeV� < ��'�� �! `�� <br /> PlJ" �LIC !A/QR�h� PERMIT Pubti<WorksFce � -- <br /> TotalF�c S_ <br /> LessAp�l FcePala $ <br /> Print or Type Cnly e.,�����o�� S ��� <br /> y� n �1 I <br /> /1�(?�14yt1 ,r.lvfti /"�_-�,1��� !—A�c.n_ .S�v i�.� S �OS 3—ZG�S ' <br /> Owner Matling Address Ctly Zip Phone I �r <br /> �i ''� <br /> Jfii11 � � <br /> Applicant Mailing Address Ciry Zip Phone ! ,•i� <br /> ,1 � i <br /> DescribeProposedWork __/J/,�i.a1 S,,.q��p �j�NtT(yM/�� f�� „S �-Q/�h/ ����� <br /> Projec�Addresslif known) _l v'7 7I� — ��1��_ � <br /> Attach four(4) copies ol plans for proposed work- Draw to sc21e and note the following as applic�ble � <br /> • Property Lines • Centerline of streel /w <br /> • Outline and dimensions of all existing and • Indicate North �) <br /> proposed structures onthelot • Show any proposed g�adin9 changes �� <br /> • Existin� and propesed u�ilities O Show measurements � <br /> DO NOT WRITE BELOW THIS LINE ' <br /> PEiiM1T CONDITIONS � <br /> i.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and cwrent City of:verett Design and Construction <br /> Standards and Specilications. i <br /> 3.Call Location Undergreund Service 48 his befoie you dig.TOLL FREE NUMBER 5-800•424•5555. � <br /> � � <br /> �p <br /> m/ <br /> � <br /> � <br /> ACKNO':VLEDGEfdENT Of- CONDII�IONS <br /> The undersignnd ownedappllcant hereby agrees�o hold and save harm� <br /> � � less tl�,e City ol Everett from any and all claims for damages, cosis. <br /> ��"� � ' / � expenses, or causes ol action that may anse because of installation <br /> �� 2'�� .�% �/�" /ly,�, �� . ��'B and maintenance of the improvemen! or other righbol-way use hereto <br /> Appwved�onstr tior, Date applied lor and furthcr agrees lo remove same upon no�ice Irom the <br /> �. City and to replace publ�r,property damaged thereby. <br /> i, <br /> Ct: / � / •) ��/ ��'7/�,/�9L) ( � <br /> FINAL INSPECTION �l� �Date ' "�r ,/( //7"' L SG�r� �2 .� �> � <br /> Approved as Constiuded S nature ol Apnlicant . Date . <br /> everett PUBLIGWOHY.SDEPARTMENT VdORK AUTHORIZC-D 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> I� Everett WA99201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY �E <br /> Phona 259�t3910 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � PROJECT OVER 90 DAYS DURATION. <br />� <br />