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;: . . .. .- ... ,. . <br /> . ---- - • <br /> �/.� i� /� r Q 1 'J <br /> Date_-,T���[C y PuOlic Wo�Fs PermR• �7� �J� <br /> � Sfn /f R� <br /> Application For BIOB�Dept��_ <br /> PUB�.IC WORKS PERMIT PubTolalFeaFeB : - <br /> Less I oPl.Fee Paitl $ <br /> eaia���o�a S=?C7 pa <br /> Print or Type Only -- <br /> � <br /> > q <br /> �v�a� �-�ny �3/ c'� - /,�/a_1:,,� �p �i�� ,4�„�.,u�����1f`037 TYS-�'l0� � <br /> _—�ner Mailing AdCrP�_ Cily� (r Zip Phone . <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 1 , <br /> � � <br /> i - <br /> m W <br /> ProjecL4ddress(if known) �L78 2 Z —' -5 — Av ' S E � I <br /> Attach iour(4) copies of plans for proposed work- Draw to scale and note the lollowing as applicable; � <br /> • Property Lines • Centerline of strezt � <br /> • Outline and dimensiuns of all existing and • Indicate North <br /> proposed siructures on ihe lot • Shew any proposed yrading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO N07 WRITE BELOW THIS LINE O <br /> PERM�T CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- nhone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br /> Standards and Specifications. <br /> � 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � G�HDE Lor Sc� F'ss Nar To Z�n�,9cT JLr2r�o�.r/o;,dd- r',��,��r,ES; O <br /> S. 4u�.�/E� ,PESs�a.�s�acE F;� C�EA� -v.� c,�' Si,pEE7'S' <br /> � SiDEwAC,tS <br /> lo. ,��morE �.P�,swic Mf!%E.P�9L o.P d��,� c.J�.�em:T � <br /> � TE L7�'xdidSPoe%:f /N jv Sr/S.—cirl �✓�%E.t'E .�.�iJGiCi9li'G�. � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi�ned owner/applicant hereby agreas tc hold and save harm- <br /> less the City of Everett f�om any and all claims for damages, costs, <br /> /� 7 expenses, or causes of action that .aay arise te:cause oi installation <br /> �-����z.— / l.j �G and maintenance of �he improvement er other n[Pub-ohway use hereto <br /> Approved Ior�Consiructi:,� ate applied lor and furlher a9rees to remove eame upon notice Irom the <br /> City and to replace public p/roperty d/am` aged thereby. <br /> � W����f/� Yi���iNl SS nI a"i�✓j�W�. <br /> FINAL INSPECTION � Date Q' � �'� - —�� ��Z`y�� <br /> ApVroved as Constructed Signa ure ot Applicant Date <br /> everett PUBLIC WOFKS DEPARIMENT WORK AUTHORIZED BY THIS PERMIT �dUST BE STARTED WITHIN <br /> � 3200 Cedar Streel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETIOPJ. 7HIS PERMIT MAY BE <br /> Fhone: 259-8815 CANCELLED BY THE CITY UPON ANV STOPPA�E OF WORK ON THIS <br /> PROJECT OVER 90 D.aYS DURATION. <br />