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. .� , <br /> Date i /���/.FLr P�e�,��vo,h�P�•,m�< f��'S�[�� <br /> I Application For Bldg Dapt.r_k���� �s��\ <br /> PUBLIC VIOURKS PERMIT PublicWorksFao <br /> Tolal Foc 5 <br /> Less AppL Fan Paltl $ o� <br /> �,�,��� �� s an _ <br /> Frint or Type Only --- <br /> o= i / � � < Ci-4�L'1 -�Ir� c; ��1 `�� �< � ; ��I � = �� )-( � �i�'�� � <br /> `��S � _. .._ � fl�r ,Z—J �';Y..�-�- � i � :<_ . .-, _ � ';�f 1 <br /> Y�Cwr.e� � MailingAddress City Zip Phone <br /> � -`�z-n1f� C•L`� ��-l'�L`ln� — - - <br /> AppLcant Mailing Address Ci�y Zip Phone <br /> Describe ProGosed Work� ���%��Lil 1� (1 �� � �mt_�'r- �C�,7�Y�1 � ��.�' I��,1��(��-4� _ <br /> � �� <br /> - /Zoo� - �—'' ,� W <br /> Proiect Address(if known) �� .v�f'�5,.E. LoT 8 � <br /> Of' Sic✓.E.e .r6 <br /> Attach four(4) copies ��f plans foi proposed work- Draw to scale and �.ote Ihe following as applicable: visr9, e <br /> • Proper�y Lines • Centerline of s�ree� �^ <br /> • Outline and dimensions M all existing and • Indicate Ncrth V� <br /> pn;posed struclures on the lol • Show any prop�sed grading changes <br /> e cxisting nnd proposed utilities • Show measurements <br /> DO NOTINRITE BELOW THIS LINE � <br /> PERId1T CONDITIONS � <br /> t. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design ana Construction <br /> Standards and�pecificalions. <br /> 3. Call Location Underground Service 46 hrs. belore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �i�, �p.r.u/EcT .�aB� To,� l�oa�.t�t/v�Pov7'Z�S To O <br /> /�/.DE i�nt/iGL�O, <br /> .J�. �.?s�Oc Gv7' Sta �S NOT To .Z�i'ri.of/c'T � <br /> SUi�cW/NOFd� LOTS_ � <br /> �, NOTE`.� S.�y'�trlf��,e C.2i�l,�E1J� 1�,��;.���✓aY C,�f�c,eEO��.zo,tFi✓• � <br /> a <br /> ACY,NOWLEDGEMENT OF CONDITIONS <br /> Thc undersigned ownedaVPlicant hereby agrees to hold and save harm- <br /> � less the City of Everett Irom acy and all claims Wr damages, cosis, <br /> expenses, or causes ol action ihai may arise because ol instal�ation <br /> �� �, and maintenance of ihe improvemen� or other right�uf-way use here�o <br /> '�""�" ���"� / `� applied for and further agrees to remove same upon notice Irom the <br /> Approved for Con truction ate City and to replace public property damaged ihereby. <br /> ���f���l �+.�DCt�r� Yv� �'rn,���� � <br /> fINAL INSPECTION \ Date <br /> Approved as Constiucted \\ Signature o(Applicant ate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOHIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 180 DAYS OF DATE PERMIT IS ISSUED AND "iHEREAFTER IS TO <br /> 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON A�Y STOPPAGE OF WOPK ON THIS <br /> Phone: 259�8d15 PROJECT OVER 90 DAYS DURATION. <br />