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a <br />n/� �:. <br />Oate�� 9('1" <br />F�U�LlG <br />U <br />O <br />O <br />Frint �� Type Only� <br />ri <br />H <br />T <br />Describe Proposed Work <br />Projeci Address {if known) <br />-. G �7- z9-s� : . <br />Application For (� /�G S r� ti� <br />aIVOFiKS PERMI� ��/%/c� <br />ooc�inoo ain <br />O U O 0.� lfl O O t�� <br />C•1 117 O V� .Y O O l� <br />�'.�' V} 1}l bi �'.� M' f <br />�3' '_4 W t4 W VJ <br />W tl+ <br />�, U' S'__.� <br />O'u� L�UJ <br />J J W .J <br />fi:� 0. � fi iil <br />Mailina <br />i�y <br />L�IY Zip <br />f/7 <br />Attach four (4) copies of plans lur proposed work - Draw to scale and no�e the following as applicable: <br />• Property Lines <br />• Outline arid dimensions of all existing and <br />proposed strudures on the lot <br />• Existing and proposed utilities <br />PubLCWorF6Parni ������ � <br />Ol�q Ocpt. v ��L�,�,��j__ <br />Pum¢ Worts Pee <br />Tolal Fee S — __ <br />L 55 FpPI. Fee Pai� S__ <br />6alanca0u^ $ ���'�' ��'-- <br />• Centerline of s;reet <br />• Indicate North <br />• Show any pwposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be ma�e 24 hrs. �n advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Lo�ation Underground Service 48 hrs. hefore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />`% �oo� foP f>oc�n S�o���.t I nusf 6e f�/� fl�nec/ fo �`'l�e <br />Sioc:Se.:cle/' n� ��S �d[�5::. <br />5- ,S:o�� .S�ewzr �r'_�.n /iou.re r�e.r��+o� mvst 6e i-ovf��i <br />!1 rr.�t'n0� 7��i/.f /1eW �oU.R-' /� /f:t f'oU.�c�' f"�/�t f�-� <br />cXiS�i�� sec,:'�r /J C_'�7�/,�" <br />� <br />��. � '�i�� � f'n <br />ApProved for Co yrEtion , Date <br />� fv <br />� ��^ ��._. �U– /• i/ <br />FIhiAL IN51'ECTION Date <br />Approved as Construded <br />everett PUBLIC WORKS DEPARTMEPI'f <br />3200 Cedar Street <br />Everefl, WA 982J1 <br />'� Phone:259�8810 <br />� 7`��:; 6Ui�dn9 �Do�•�r7i•.nf. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />♦r^ <br />V♦ <br />a <br />�. <br />The undersic�ned owner/applicant hereby agrees to hold and save narm- <br />less �he City of ��verett Irom any and 311 claims for damages, costs, <br />exoenses, or ca�ees of action that may arise because ol ins�allation <br />and maintenance of ihe �mprovement or other right�of-way use heretc <br />applied lor and Iurlher a9rees to remove same upon notic^ from !he <br />Cily antl to replace public f'eperry damaned thereby. <br />S`qh��tu tAPP����—•r — <br />Uate <br />�:7::RI< AUTHORI2ED�NV THIS PER"df: f.' 15�,' 9_ STHRTpD WITHIFI <br />id.i DAYS OF DATE FL'RMIT IS ISSUEi�� :1'�U THERENFTEf3 IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CFlNCELL.FD BY ThIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PP.OJECT OVER 9G DAYS DURATION. <br />