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I: ate ���/X� <br />AppPcation For <br />Pll�Li+C V1lC)�KS PERIVIIT <br />Prirt or Type Only <br />PULi�t Warks Permi� s �j <br />d'G-� <br />91d9. �� . s f�11 ��/ � d __ <br />Pu�lic Warks Pee <br />To il Fee W - <br />lose AppL Fee PaiO $ <br />Balance Duo $ �n � <br />�1/h 3 � <br />=/�u� c��r.,; �� � —.z:� r � <br />r�IFPR l. 'iC'r,;u-• c�.r.—// � s. �U.`f �.C� "�.�0�1 3 S� � c <br />wner PAaiiing Address City Zip Phone <br />„�i/t/�G� u�N �5=�'��-� <br />(�' n v ,o � � R �i4-/ U✓� � ��� — � � <br />.<'�.�;.v C.�i� T%7 � f!o'�N�� hi f S, � c�✓2 �fi / ✓o <br />Applicant Mailing Address �ity Zip Phone <br />i " � <br />Describe Proposed Work �G! � _, i�f.'�: C- ,"—p-,at ,%� y/l,�9-L�, <br />j, <br />—_. ,''/ ^ J_=__ <br />Project Address (if known) � �� �7 — ���(�t� �c��-`i' �'-%%� G!/T-�. <br />rJ, �_ <br />Attach lour (4) cop�es ol plans (or proposed work - Draw to scale and nole ihe lotloH�iny as spPlicable: <br />• Property Lines <br />• Outline and dimensions of all er,isting and <br />proposed structures on the lot <br />• Exisliny and proposed utilities <br />PERMIT CONDITIONS <br />,f. U i. <br />• Centerline of atreet <br />• Ir.dicate North <br />• Show any proFosed �radina chanyes <br />• Show measuremenls <br />t. All calls for inspection shall he made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with lh;s permit and current City ol Everett Design and Cons�ruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />T. SiO�cu�1 � �C .� v.ePv'" � GU/TE'-,�? � E.UEiJ .� l,��J6�"o.f Fn/ <br />. <br />�E•e CEP�' / S/�'fGGL C'.2.aC�`" /�✓ S/Gv � S�udvcS N, of' O�✓� <br />O�� Lid�1QG� /Y/UST B� it'�i�i1.i,2E/� �y fl/�i'�i�C.tl%. <br />�� f�. �j.E'dOi•t/f OT/ %y� C:tJT S/Y.OLL fi'E �%U.�� SL% <br />,qs��,�p% jp 1nf�dC% T//E r9t�.i-�CEnJT" L:J%S LJ/iH <br />,f^',Gnl- v,.A'•—e;e �f''v.U•aFi'f <br />`?������- �/��� <br />AFProved.(or onstruclior / Dnte <br />l�W <br />-7�3 o y- <br />FIPlAL INSPECTION Date <br />AUProved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, \NA 98201 <br />Phone:25g�8815 <br />ACKNOWLEDGEME�IT OF CONDITIONS <br />The undersigned o�mcr/applicant he��. y agrees to hold and save harm� <br />less the City of Everetl from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of install��.tion <br />and maintenance of Ihe improvement or other rigM�oFway use hereto <br />applied for aid further agrees tu remove same upon nofice from the <br />City and to replace F��blic prope�ty damaged ihereby. <br />r/ l <br />S'� a!Jre o� Apnlican r � Dale <br />WORK AUTHOR2�S PERMIT MUST BE STARTED WITHIN <br />180 DAYS GF UA7F f'ERMiT IS ISSUED AND THEREAFTER IS TO <br />BE DILiGENTLY P!'r7SUED TO COtviPLETION. THIS PERMIT MAY BE <br />CANCEI �_ED BY THC .,I IY UPON ANY S fOPFAGE OF WORK ON TNIS <br />PROJ=CT OVER 90 DAYS CURATION. <br />