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Y <br /> Date � �� �/ I Publ¢Worl:a Permil> _ " �r /Q <br /> Appliwtion For Biae�Deni.s �j S/ <br /> PUBLIC WORKS PERMIT Pu�hcWorksFee <br /> .o�a�Foa s— <br /> less PDP�Fee Paid $ C <br /> Balanca Due $ <br /> �G ^ <br /> Print cr Type Only <br /> ��P-s-a .�ao <br /> �;,� � ��,�i�i c� r.v�- Zu r �7� �/ ��F ln 7�'ti Cf i9 6 R,�.s'n,�H�/�//� q�D� <br /> p,N� � Mailing Address City Lp Phone <br /> SQ�. <br /> Applican� • Mailing Address Ci�y Zip Phone <br /> Describe Proposed Work /p�� �-!�������\�j�(�-!� � . . <br /> �_Nf ���A/0_vf C�PP l� (4V �� <br /> _ W <br /> Projec�Adaress(if know�) �� 72�' J�h ✓E S,E, � <br />� Attach'our(4)copies of plans for proposed work- Draw to scale and note ihe following as apUlicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all ex�sting and • Indicate North <br /> proposed structures on the lot e Show any proposed grading changes <br /> • Existing and proposed utilities � • Sho.v measuremeros �A <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspection ehall be made 24 hrs. in advance- phone 259-861 5. � <br /> 2. All work shall be performed in accordance with ihis permit and currenl Cily ot C-verett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. hefore you di5 TOLL FREE NUMBER 1•800•424•5555. � <br /> J', IivJ.�r,t c NEv> l�.�'�v�� f�� CiT` Sr9�✓/�•,e�� '#3C�? O <br /> AaD SE'cT.cn/ j 3 7, c�� 7�/E Po�.ac,�c k�n,e�rs ST�✓vA.��DS <br /> /Y�An.•�•�'G. � <br /> � ��5:/rl(s I�/.'i//EcJ9y %� �C �'E�"o✓EO �' .�'[i�C9fE"D � <br /> u�iTr,� Futc N.��T lU,a� � Cr�,r/C� _ <br /> lo. S:�oE«,As.c' CL�,�B � C+U.TE.:: /�,eE �v'E�✓ #" uNa"ti°o,tE�n/• � <br /> �fN1/ ,l�Pri�9CfE� T 7yEivr SiYF.'c c �c' �EfY�CFD 6� � <br /> THF f�PCiC.�'n.'T <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undenigned owner/applicant hereby a9rees to hold and save harm- <br /> less the City of Everett from any and all claims tor damages, costs, <br /> �/ //�� er.pensec, or causes of action '.hal may arise because of installation <br /> - p /tiL_� /�zL � � �r and maintenance of the improv�ment or olhe� right-oFway use hereto <br /> ���' ��� � applied for n further agrees lo remuve same upon nolice Irom the <br /> Approved�or Co � tructi i Date City and t rep ce public pr erty dam2yed ihereby. <br /> �,�,,1 �j�� �� , �S _ S� - �� _� <br /> fINAL IN PECTION � Date ^ 7 <br /> Approved as Construded Signa re ol pplicant Date <br /> evemtt PUBLIC WORKS DEPARTMENT WOR A HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 3E II <br /> Everett,WA 98201 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVEft 90 DAYS DURATION. <br />