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� PUGIn:\'/�rY;Permit a �-��" /L� <br /> oate�� �]RRF� <br /> om� r�oi , <br /> Applicalion For <br /> PU�LIC WORK� PE�M ,T PUbTolatFeaFee , <br /> Less PpPL Fee Paid $ <br /> PalancaDue $ �O�_jO <br /> Print or Type Only <br /> (��orlir, r���-mr✓7 � �� n�Aa� �A r � 4'��b y 3�3 �/�� <br /> �Y1'1��5 �7��=—� <br /> Owner � Mailing Address ;ity Zip Phone <br /> �PI(�ant� Mailing Address City 2ip Phone <br /> Describe Proposed Work ;v, �-� � ��� <br /> ��. W ; <br /> ����, p� 5i� ���,-��� �.. i <br /> Project Address(if known) _� ` <br /> �F /-nr�+/. ✓E��� � � <br /> Attach lour(4) copies of plans for proposed work- Draw to scale and note ihe following as applicable: � Yt� � <br /> • Property Lines . • Centerline ot slreet � <br /> • Outline and dim=nsions of all existing and • Indicate Norih � I <br /> proposed siructures on lhe lot • Show any oroposed grading changes I <br /> • Existing and proposed utililies • Show measuremenis /� I <br /> W i <br /> � DO NOT WRITE BEI.OW THIS LINE O I <br /> PERM�.:CONDITIUNS <br /> I All calls for inspection shall be made 24 his. in advance- phone?.&9-881 5. � '�, <br /> �. AC work shall be performed in occordsnce with this permit an d curren t Ci ty o f Eve r e tl D e s i g n a n d C o n s t r u c t i o n � <br /> Standards and Specifications. i <br /> 3. Call Lc •ation Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � i <br /> i <br /> O � <br /> �.� v'7•PEETS h°2E To �c �cr�% G'<EP�J 1)U.c'iNc'.� � <br /> �'O/✓Si�!/C%/O�• ( <br /> s , �c� Toi' aar�.d„ '��c�� Tc- L�i�c��c�c:s'. � I <br /> i.c�n.u�EC% < C�i�- I <br /> n '/ 'IJFJ (/✓f1c�L-'r'� C�9C'�c=c'''� � I <br /> G�. .'l E�'L�Le' !� �'e: � y <br /> � I <br /> � �I <br /> i <br /> I <br /> ACKNOWLEDGEMENT OF CONDITIOPIS II <br /> The undersi9ned owner/applicant hereby agrees to hold and save harm- <br /> — less the City of Everetl Irom any and all claims for damages, cosls, <br /> �, � expenses, or causes of action that may arise becausE o( inslallation <br /> �' � . ��ri /7 and maintenance of the improvement or olher right-ol-way use hereto <br /> `'_ �;��,�io _._— �� applietl for ard furthe agrees to remove same upon notice from Ihe <br /> Appreved for Cods ruc 'on i ate Ciry and to reU�ace public property damaged thereby. <br /> e <br /> 7� I 6 , �-, ) � � -� <br /> � z3 Si <br /> Date " � �.�'"-,-� (/ " n ' <br /> FINAI. INSPE TION � Uale <br /> �pp�oved as ConsVucted Signature of ApPlica t ' <br /> WORK AUTHORI D BY THIS PFRMIT MUST BE STARTED WITHIN <br /> :verett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATF. PERMIT IF ISSUFD AND THEREAFTER IS TO � <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLET:ON. THIS PERMIT MAY BE � <br /> EveretL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI� � I <br /> y/� Phone�. 259-8875 PROJECT OVE3 90 DAYS DURATION. '. <br /> � <br />