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� <br /> i <br /> I <br /> f <br />; <br />�;� � <br />� <br /> i <br /> y <br /> v � <br /> Date� � v�b���•.va�k���,mn, �7'/2' __ <br /> eioa-oeo�.a � <br /> Application For --'- <br /> PUBLIC WORKS PERMIT PublicWorkSFco -- <br /> .mz�Fon s <br /> Less An�l.Fce Paid $ --. <br /> Balarcn Dur S_ <br /> GQC�' <br /> Print or Type Only ------ <br /> �2A��oN ('n��ST. i��� I /J�, �7� Cr �'i-�-I„ ,��r►���ll��e <br />. Owner Mailing Address City Zip Ph ne <br /> Applicant Mailinc�qddress City Zip � Phone � <br /> ' 1%111 �S�ie <br /> Des�ribe Proposed Work �� <br /> /a g� ��h � <br /> ProjectAddress(ifknown) c �— J AI�� .SG' L_ <br /> r <br /> Attach four(4)copies of plans for proposed work- Dra•N to sca�e and note the tollo�w?q as applicable: � <br /> • Property Lines • Centeriine i�f street � <br /> • Outline and dimensions of all existiny and • Indicate Nor,h <br />� proposed structures on the lot • Shcw any pnposed c�rading changes <br /> � Existing and proposed utilities • Show rneas�rements � <br /> II� � DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 7. All calis for inspection shall be made 24 Ixs. in advance- ohone 259-881 5. � <br /> 2. All work shall be pertormed in accordance with this perm��.and curreN City ol Everett Design and Consiruclion <br /> Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NllMBER 1-800-424-5555. � � <br /> y; G,c^�9o�i✓:;- a.�/ <oi Ta .dE 1J.o�t/E S'o A.I �t/OT To 1`n�i�Ac i <br /> 90Toi�vNi�/[> �OTS' LdiTi/ �'9rn/-u/,9TF� il��.�'--OF{, O <br /> ,J� !�o .t/C�T pU`C/� C,f'�q.v.0 /�7L/.%Ed�iq� /.4�Tc� L�.(i�i.✓9GC A,r2a' ! . <br /> To Ti/6 El�ST, r <br /> �, +'/i✓ /��i/�29Gc 7 %/C Clli���� /:��.7r�� D.C' SLG.'C✓roG �t' l�G�i�ii./c.: � �, <br /> 7/iS �.4 Si�9Gc G�'c" �'c.��lJc!L d� %�ie` "�f��?(iC:�n,�T � <br /> a _ <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> 1 he undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of Everett from any and all claims tor damages, costs, <br /> expenses, or causes o( aclion that may arise because of installation <br /> � AJ� and maintenance of Ihe improvement or oiher ric�hl-of-way use iieretc <br /> � y �'" 7c��"L� � '2J/y J applied (or a further agrees to remove same upor, notice from the <br /> Aporoved for Con rucEon !Tate Ciry and to lace pablic o erly damaged ihereby. <br /> ��� �--' C/ �' 3�'� <br /> FINAL INSPECTIO Date � ��- ` L� <br /> Approved as Construcied Si at •e of Applicanl Date <br /> everett PUBLIC WORKS DEPAflTMENT K AUTHORI2ED BY THIS PERMII' MUST BE STARTED WITHIN � <br /> � 3200 Cedar Street 0 DAYS OF DATc PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phane: 259��^p'�'rYj CANCELLED BY THE CITY UPON ANY STOFPAGE OF WORK ON THIS <br /> PROJECT OVER 90 UAYS DURATION. <br />