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J/e '' d!_ ' Public Wo�ks Parmil• "'� ' ��� <br /> 84 a � ��Z �dh <br /> eme oea�.. <br /> ' Application For <br /> PUBLIC WORKS PERMI7 PuoToelFeeFee s <br /> Less Pppl Fee PeiO S <br /> Balanca Due �� � <br /> P�int or Type Only <br /> �I.EiLeR # SouS �►+c. �124 139� PL• S.E. 8otl,�fl UN1• 98011 745- $3?� <br /> Owner PAai{ing Address Cily Zip Phone , <br /> SAmf — — <br /> ApplicaM Mailing Address City Zip Phone <br /> DescribeProposedWork $IF N:EW �hES10ENcF '}b bE bkl�} <br /> �d�as - W <br /> Project Adaress(if known) <br /> }g� S�' q UE S.E. c VEREit �o'+ */o wFstcREEk Di� ]z � <br /> lttach tour(4)copies of plans for proposed work• Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed sir�ictures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � • Show messurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- Uhone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> 5tandards and Specificationa <br /> � 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•SOO•424•5555. � I <br /> �, �B�'iovE �GAy'G ��'¢i5 ��•� LoY, DO.�rl .Lk�sN oF?�' � <br /> o.uro Ao.�o..vi.✓rs �,eooE,�j� <br /> S, k/.9�cf/ Fo,e h'1A�/�f'o�E F,qrne Co�,e�o [.uiry Di,eT � <br /> �Eyi,vD C/Ty SiOEWFdLK . TN� ,�JPPUl9�l Wi�G BE � li <br /> /PESPoNLidLE foR �9n/y DAm9GE r0 /T O I <br /> �. SiDEWA•c�C �' D.QiuEcJ9y H.eE .t/Ec� � u�vDAin9vE0, <br /> TNE APDu�9nrT W//L BE .eESPc�cti.BGe� ��.2 �PEPG�Yu.w I <br /> ff,�,� TN�9T /S G19,r�A6�'•O 1,Yi,ci�/C,r CdcJ.S7",PU�'7n� I <br /> AGKNOWLEDGEMENT OF CONDITIONS I, <br /> The undersigned owneUapplicant hereby agrees to hold and sava harm- ; <br /> — less the City of Everett from anv and all claims for damages. cosis, i <br /> expenses, or causes of action that may a+ise because of installation <br /> � and maintenance of the improvement or other righbof-way use hereto <br /> • e�X� �� "'� aPPlied for ;nd further agrees to remove same uPon notice from the �� <br /> � Approved for Const uction y i a1e Ciry and to replace puhlic property damaged lhereby. <br /> �(,,l��t' C a.� 9 - �'� I !3� _ .. �.-�QQ�1�,. <br /> FINAL WSPECTION Date — ��—� — �. <br /> Apo�oved as^un;tre�ted I Si;nature of T�pplica�t Datc , <br /> � tNORY. AUiHOGi1ZEi` 9Y THIS PERMIT MUST BE STARTED WITHIN , <br /> everett r^UpLIC WORKS DEPARTMEFiI �g,� ��,�;yg pF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200 Cedar Slreet I !SF. DIL�.��\fl'I PURSUED TO COMPLETION.THIS PERMIT MAY BE � <br /> Everett.WA 9d201 CANCELLED BY�IiE CITY UPON ANY STOPPA3E OF WORK O�a fHIS <br /> Phona 259•8815 pROJcCT OVER 90 DAYS DURATION. <br /> i <br /> �� <br />