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�i c��'i9 .`y'- ' _ <br /> IDate I� y '�) Pu�ImltiorksP Tmli��: ^ ��� <br /> ApplicationFor ew9.oeP�.+?(c�' / � / /� <br /> PI.�BL.IC WO�K� PE�MIT PuOTataiceFen 5 <br /> Less FO��Feo Pma 5 <br /> .�-��— <br /> Balancc Ouo $ <br /> Print or Type Only — <br /> � , / . 1 7� <br /> --/1� 9G�a�� C ft.tr`�-ri �`' J' t <br /> ;i .r �v v l'�--, .Cc�� � � .Sl —�l"o�rri� <br /> Owner T— Mailing Address City Zip Phone <br /> `V V r\� _ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Worn ��.c>�—e-� ��Q-�v�-C.X��s�w`ca-1'� �� <br /> s <br /> — � <br /> Project Address(if known) � ��� l �� � 'S� � <br /> Attach lour(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline o(sireel /^ <br /> • Outline and dimensions ol all existing and • Indlcate North y� <br /> proposed structures on the lot • Shov:any proposed grading changes <br /> • Existir�g and proposed util��ies • Shcw measurements � <br /> DO NOT WRITE BEIOW THIS LINE ` <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•8$�5. � <br /> 2. All work shall be performed in accordance with ihis F ermit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> I � 3. CaL' Localion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> P <br /> 5! To BE �"o�'✓sr�vcTFO PE,�' !��<�iov�o �SiTF O <br /> fl/��v �.9i�U i2-i/-9� - <br /> ��/� <br /> V♦ <br /> 01/06/87 10:50RH OOOf�ti?•549 f:t <br /> / ii <br /> k100017445 <br /> uF'T.:� �52.18 <br /> � F'W FC �3�,00 <br /> Pi�IhJSF :�OL.00 <br /> ACKNOWLEDC�Ety1E(�j'O�j�tJD1�lONS <br /> The undersi9ned owner/appli����reb�tQYd$g4d hold znd save harm� <br /> less the Cily of Everett from any and all claims ior damages, costs, <br /> expenses. or causes ot action that may arise becouse of ins�aliation <br /> `,���m ��_ � and maintenance o� �he improvement or olher rir� `�way use hereto <br /> � /` /��� applied for and turiher agrees to remove samr •.��on notice from ihe <br /> � Approved for Constr ction Date Ciry and to r place publ1c property dar�aged �hereby. <br /> � , �i� �c�.�J �0.rJ �els C,eUti�t. <br /> �"��' _ (�a�e:-f�/ ��� ,— � . <br /> FINAI INSPECTION D2te <br /> � ��. c � � <br /> Approved as Constructed Si na� re of hpplicant Date <br /> n��etett PUBLIC WORKS DEPARTMENT WOR AUTHORIZED Bl' THIS PERMIT MUST BE STAP.TED WITHIN <br /> � 3200 Cedar Street 180 DA1'S OF DATE PFRMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,NIA 9A201 BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-881 5 CANCELLED BY THE CITY UPON ANY STUPPAGE OF WORK ON THIS <br /> I PROJECT OVER 90 DAYS DURATION. <br /> J <br />