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� <br /> [late� Pu�llc Works Permit a _ �_� <br /> ♦ <br /> BIEg.Oept.s� � <br /> Application For <br /> PUBLIC WORKS PERMIT Pu0licWarksFea <br /> Total Foe �— <br /> Less AOPI.Fee Paitl $ �Q� <br /> Balanco Ouo $ <br /> F'rint or Type Only <br /> ��osa <br /> �a ,�,,.� �� ��5� i �7� 1 n►�. (�7�' ;4 ��+-I vn �� � ��9 m <br /> O er Mailing Address Cdy Zip Phone <br /> �<i{�M� <br /> � Applicant Mailing Address City Lp Phone <br /> Descrite Proposed Work � ���� � � �F� . <br /> - - W <br /> ����1� S� /-I\�`I ��' LoT°°`7 of �✓C. 'r�2 � <br /> Project Address(if known) - <br /> Attach four(4) copies of plans for proposed work- Draw to scaie and note the following as applicable: � <br /> • Property Lines , • Centerline of sireet � <br /> • Oulline and dimensions of all eristing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Sliow measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIOI•!S <br /> t. P.II cails for inspection shall be made 24 hrs. in . � o�..a:e• phone 259•881 5. � <br /> 2. All work shall be performed in accordance Hith tnis permit and current City of Everett Design and Construction <br /> Standards and Spercitications. <br /> 3. Call Location Undergrounc 5ervice 48 hrs. belore you dig.TOLC_FREE NUMBER 1•800•424-5555. � <br /> 7' CU.eB/ C-UlTE2 � SioEcJAt.e f3.2E ,v�uJ � !<.r/B.��D,�F/f�. <br /> . - N� C G � �A� �=o O <br /> 9 � 9 <br /> .9/�i�L�C9�T `✓!G ST �c f��9LE . � � � <br /> 1,U2i�✓G �ONSTiZUCT�d/� � <br /> .S �_F•v SlvE7a�t9c,(� �" cS'T.C�E�T �rLFAi✓. ♦/� <br /> V� <br /> �. ��5� �.�,5;,,�� �,�,�E���y o,� ,�E.��E �.�,��w�y O <br /> PE2 SEC%:O�✓ ,�.3.7. 9•cl0 h�Ein/STfi'GL f��� �S'TA�/G192L� �-�7 � <br /> (�,k.Q. 9�l r9 — ��`� c� . <br /> �j(j 5 ' �gJl7 <br /> ACKNOWLEDGEMENT OF CUNDITIONS <br /> The undersig ied owner/applicant hereby agrees io hold and save harm- <br /> — less the City of Everett from any and �II claims for damages, wsts, <br /> � expenses, or causes of adion tFat may arise hecause of installation <br /> 7 and maintene�nce ol thc improvemenl or other righirof-way use herelo <br /> �'% ��d� � ��- applied for and further ayreEs to remove same upon notice irom the <br /> ApProvad t Conslru ion ' /Date City and to placa publi �•property damaged thereby. <br /> r � � _ _ <br /> � I <br /> �� , �� ' � � � -� lS -�� ��, ' ���v-�� I� <br /> FltvAL INSPECTION Date .-----�•-•----- �, <br /> ApFroved as Constructed ` Si at re of;ppl:�',;r' Date <br /> everett PUBLIC 1NORKS DEPARTMENT O AUTHORIZEC� B1 THIS PERMIT MUST BE STARTE� WITHI� <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> '� 3200 Cedar SU^et BE DILIGEN'"LY PURSUED TO COMPLETION.THIS PERMIT MAY f�E <br /> Everett,WA 98201 CANCELLED �Y THE CITY UPON ANY STOPPAGE OF WOFK ON Ti�dS <br /> V Phone: 259-8815 pROJECT O\'ER 90 DAYS DURATION. <br />