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i <br /> � ; <br /> I L,� <br /> I Y <br /> I <br /> i <br /> Date��`�q ' �,��,���wo,h�va,mp,�.. _ <br /> AppliCatien For Uinq oeo�.. _a��caZ��—_ '". <br /> Pl1BLIC WORKS PERMIT P°�;�WFp�F`r S_-------- ' ���� <br /> Less Ano�.Fee Pai� 5 <br /> BalanceDuc $ <br /> Print or Type On�y — <br /> '� u V, �Prv�r: � 5�R13 -5�� /�Q_ �✓Pi' /f_j�`�aD3 35S—S�cP9 <br /> Own Mailing Address City Zip phone <br /> Sr� w� � _ _ <br /> Applicant Mailing Address CitY ZiP pho�e II <br /> DescribP Proposed Work �{,(,�.�_���y� /29 J�f-rf���^�^ � �i/�� <br /> .�_�_._���a._«— T <br /> Pro�ed Add�ess(il known) �o �,3 �����` � <br /> � <br /> Attach fo�r(4) cop�rs ol plans for proposed work- Draw to scale and note ihe folloviing as applicahle�, � <br /> • Property Lines • CenterGne of street � <br /> • Outline and dimensions ol all uxisting and • InCicate North <br /> proposetl stfuctures on ihe lot • Show any proposed gradiny changes <br /> � • Existing and pronosed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.All calls for inspection shall be madz 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with ihis permit and current Ciry of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 46 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> I <br />.. . "� / , . ' � <br />� � �(� J�,QiyiJv�u,f ./!/L�� /�i/' i ,�' - ' � 7 <br /> . .0�C . � � ` <br /> � y '�C�?�2�15_ r— <br /> ��_''? _:;o <br /> _/ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONC'iTIONS <br /> The undersigned owner/applicant here�y agreee to hold and save harm� <br /> less the Ciry ol Eve�eli Irom any and all claims for damagea �osis. <br /> expenses, or causes of action ihat may arise Secause of instaliation <br /> and mainlenance of the hnprovement or other righl-ol�way use hereto <br /> applied lor and further agrees to remove same upon notice from ihe <br /> Approved lor ConsVuclion Dale Cily and to replace pubhc property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construded Si9natwe ol Applicant Daie <br /> everetl PUBLICWORKSDEPARTMENT V40RK AUTHORIZED BY THIS P[RMIT MUS7 B[ STARTED WITHIN <br /> � 3200CeAarSireet 780 DAYS OF DATE PERMIT IS ISSUED AND TIiEREAFTER IS TO <br /> Everett,WA98201 8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A4AY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPP�GE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />