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Date�`S�� .s«= P��,�,�"-o,�a,,,m��o <br /> � �c;4/J,�/T oiae Den� _ — <br /> . Applicalion For ,�t ps—/�S9 <br /> Pl1�LIC WG�RKS PERMIT �/ PuhIiCWOd9FeC <br /> Tolal fee S <br /> Less ApO�-Fcc Pa� <br /> �,�I ^ �� i � �aiance Due � <br /> Print or Type. Only W" 1 ��'L'E'/�'i"�'� y �� <br /> S'/'/EiC'�I`'c�n�_ .1'DC''. �?7.Sc� /'%�f'T//�f' av�9Y' BEtGc v�tr cv,9 5`Proj� <br /> Owner Mailing Address City Zip Phone T <br /> ���7.�'— ��n".� <br /> Gc�/YJ S�:C'�iQlJ �C'G> /�JC �o o /SG l�N. c. .s c.riT<�'-� <br /> Applicant Mailin9 Address Cdy Zip������AhOne�F, ��,L,, <br /> i i <br /> Destribe Pro�nsed 1'�crk T �-�N�C /O o� ��7 (-'��d�'" ��Gry <br /> �.Sou'r/�o�= �'/�,SC/� /�i/-�iJ /J�'T. Ta cLl�/n�/�T� -- <br /> C�cs� vF _��;V o�'1! �'ri i�YY�P��'�-%Jr cu�?piG'�c,�� <br /> �s.airr /v ' ��.es 1J !��r.�7—=� �',•s' to�lJiro�J oF r/�i<r /'�'c,r—c�- W <br /> Project Address(il known� �—' =�� � �� S%i cc— H <br /> Atlach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Proper�y Lines • Centerline of street ♦^ <br /> • Ou�line and dimensions et all existing and • Indicale North V� <br /> proposed sVuctures on the lot • Show any proposed grading r.hanges <br /> O Existing and proposed utilities • Show measurements /�/� <br /> W <br /> �a�_� DO NOT WRITE BELOW THIS LINE <br /> Pt�M1T CONDITIONS � <br /> i. All caii��nr inspection shall be made 24 hrs. in advan�e- phone 259•BS'I 5. � <br /> 2. All work shall Lc nerformed in accordance with ihis permit and current City of Eve�ett Design and Construction <br /> Standards and Specin�ations. <br /> 3. Call Location Underground Sarvice 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-55b5. � <br /> �' � , /�. �v ���t/,�.,JT ��•� l��r�.�r /,?«� O <br /> i�lF������JT. <br /> `'� ��/l?csT/� Fc�tlCc � � ����ir/-:-e 's <<.>,� T �F � <br /> u%.f'rc%�i��J dy �'. ;i� /r-`_.— r.J?�=iF� `�J�:�-.— <br /> _ — � � <br /> � <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> The undersic�ned owner/applicant hereUy agrees�o hold and save harm- <br /> less ihe Cily ol Everett from any and all claims tor dainages, cosis, � <br /> expenses, or causes ot actior, that may arise because of installation <br /> �/��,���j i� // and �iMenance of the improvement or othey�ighi�afi�vay use hereto <br /> " '�L---��� ���7�� ap ied�for and furt�h r 2grees to/�move sgme upon notice Irom ihe <br /> Appr ed tor Co ructio i�? Date Ci �n o � ro eFfbiYama thereby. i <br /> a!-�Y� ` � � OPY�f��� �V��11 . <br /> ! � <br /> ��� GI'. 1 z -d'.6 �` �� _3 I <br /> AL I SPEC710N �a1e j/ ', • ' r�. % � �:�� r � <br /> Approved as Constructed Sig�aWre of App ica . ,, ,�. � `/���jL, <br /> everett PUBLIC N'URKS DEPARTMENT WORK AUTHORIZED B THIS PEFMIF US7��STA ITHIN <br /> 180 DAYS OF DATE PERMIT IS I5SUE� AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY �E <br /> Evere�t,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOAK ON�i HIS <br /> Pr�one: 259�8815 FROJECT OVER 90 DAYS DURATION. <br />