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oace �;G3-[�' � . • P�����wo,ksP���,��. b'�,_`fOlo <br /> iippucalion For emn.o�m �• ���— <br /> Pl�BLlC WORf�S PERMIT PJOTcaIFecFeo 5 <br /> Less Appl Fee Pa�J $ <br /> Balanca Due S 2O� <br /> Print or Type Only <br /> �ic G��.c��;��s' 3S�/ 3 /a ' /S� - c��'�-'T �'��•� 7�/l2 _ <br /> Owner Mailing Address Ci�y Zip Phone <br /> \ I ( ; 1 l � � � I / <br /> Applicant Mailing Address City Zia Phone " <br /> DescribeProposedWcrk _/�t�!/� �t»'1ft/'C•�T/n�-t f�c'�9�-t <br /> /Z���� �� �/� /�� .S� E �n<�r�� �,F t�is>A. � <br /> Project Address(i!known) � <br /> Atta :four(4)copies of plans for proposed woik- Draw to scal�and note the tc Ilowing as applicable: �� <br /> • Propeity Lines • Centarline ol strezl /� <br /> • Outline and dimensions of all existing and • Indicate Nertn V� <br /> proposed structures on the lol • Show any proUosed grading changes <br /> • Exis�ing and proposed utilities • Show measuremenls � <br /> DO fvOT WRITE BELOW'THIS LINE � � <br /> PERMIT CONDITIONS <br /> t. All calls(or inspection shall be made 24 hrs. in advance- phone 259•881 5. q <br /> 2. All work shall be performed in accordance with ihis permit and curren�Ciry ot Everett Design and Consiruction r� <br /> Slandards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> � �Ce.rl L�ou/�us oouiS r� eSTe%BS s��vci/aEt�, � <br /> S CU.�'8 Ga�7'E-2 g SiaE�uFJ.c,C F�2E �lE'cJ .9N0 cC/t�.0.?m9Cr�'O. <br /> y..�y �.�.�,�:�-E- T r,�c�n ss���c r�E ,�E�<acFo 8y � <br /> THE �,p��,�•�.�,%. � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owncr/applicant hereby agrees to nold and save harm- <br /> less ihe Gity ol Everett from any and all claims for damages, cosis. <br /> pq expenses, or causes of aclion that may a�ise be�;use of ins�allation <br /> ",Py�L; y�- /,�//8�n and maintenance of ihe improvement or of.ar ri;�h,-of�waY use hereto <br /> , �� '�«� ''� applied for and lurther agrees to remove same upon notice Irom the <br /> Approved for Constru tio Date City and to replace public property damaged ihereby. <br /> . Z / 7 ///, <br /> FINAL INSP TION � �� UaTe �C ( ��/�u <br /> Approved as Constructed SignaWre of Appliwnt Date <br /> everett PUBLIC WORKS DEPGRTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> EveretL WA 98201 8� DILIGENTLY PtIRSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Phone: 259-8215 CANCELLED BY THE CITY UPCN ANY STOPPAGE GF WORK ON THIS <br /> PROJECT OVEH 90 DAYS GJRATION. <br />