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��.�,_ w <br /> a � $i � � <br /> Date �`�J— -��� `y}/�,' <br /> Pubhc Ylaks Poi t u . <br /> f)Itlg.Depl.C���t' <br /> Application Fo� � ' - <br /> PUBL6C WORK� PERMIT I�ubtotWFeeFae S <br /> I.ess Appl.Fec Paid $ <br /> �alance Due S 2L n0 <br /> Print or Type Only �,��a� � � ;� _ ���// <br /> '"7 <br /> �d�TN�,�,,,�_ �� �a� - i ���s�J .„�,�� ��?�� <br /> i!wner N.�iling Address City Zi Phone <br /> —.�h�u=.= — <br /> Applicant Mailing Address Ci�y Zio Phone <br /> i--� <br /> Describe Propo:e�i Work __5��.�� - — <br /> Prcject Addreas(if knowN l v �G QQG _ �/C�fh v��%r�' — � <br /> � <br /> /.tlach four(4}copies uf plans for proposed work- Draw to<cale an•i n.:te the following a�appliwble: �� <br /> • Property Lines • Centerline of street ♦^ <br /> ` Outline and dimen;ions of all exisling and • Indica�e Norih V� <br /> propwed olruciures on the lot • Show any oroposed grading changes <br /> � Exis�ing and proG��sEd utilitiea • Show measurements /�/� <br /> � DO NOT WRITE BELOV!THIS LINE � <br /> PERMIT CONDITI7NS � <br /> t. All calls lor inspection sYall be made 24 hrs. in advance- phene 259•881 5. � <br /> 2. qll work;hall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificatinns. <br /> 3. Call Location Undergrnund Se:vice 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. o�' <br /> i � OO.vc� LK T//c �� <br /> 5� .Q� ��,����ti�> ' �OT S/��GG NoT � <br /> //'1,dC.i Ti�E� Sv.�/�dci�'Di�/G� LOiS GL'/JiY ��Ai:t'-�fdGTESr� <br /> �U/!/• L��7` � <br /> S. iPGP�� /��Gvill.f'F'l/c.�iS T' 6'� TG�Yl- Li+.•.!iJ TL� ♦A <br /> � 7Tf/E� l�.LtJiN.c/G-�� SySTE�n. i/♦ <br /> �v. �/ � C4!''.�d's .9.t'E NEvJ�: uNl>.drnd�E=- .�1,� 1>G�tIG�E V�1 <br /> To T�E;�-.� ��i�c �Eq��,eE �E PevcE.n��✓r ,�y ��sE Y. <br /> � <br /> �Pr'�,ca�✓: . <br /> ACKNOWLECGENENT OF CONDITIONS <br /> The undersigned owner/applicar�hereby agrees;o hold and save harm- <br /> — less the City of Everetl Irom ary and all claims for damages, costs, <br /> ezpenses, or causes of ar,tion that may arise because ol installation <br /> �/ � % � and maintenanca o1 !he improvemen� or other nyht-of�way use hereto <br /> u=�G���'='�'��� �� �G' �-� applied for and lurther agrees lo remove same upon nolice from ihe <br /> Approved tor ConstrucUon Date City and to replace public pwper�y Gamaged thereby. <br /> � n <br /> �, � z� g �'�a,t-���°��— <br /> FINAL INSPECT� N Date -- <br /> Approved as Constructed Signature at Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK Ai�?HORIZED Bl' THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTEG IS TO <br /> � 3200 Cedar Street BE DILP3cRTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Eve�ett, 'NA 99201 CANCELLEJ BY THE �ITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: �E9�P.815 PROJECi OVER 90 DAYS DURATION. <br /> � <br />