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ri .. ' � — <br /> Date . •' ; ��_. �5_ ;� <br /> T— PUGIit Woiks Perml!a <br /> � Appiication For amp.ucP�.b _ _ <br /> PUBLIC WO�KS PERMIT' Pu�TolalFeoFoo 5 <br /> Less Apol.Fca Paid S ��, <br /> Print orType Only BalanteDuo s �.��c�c� � I <br /> I <br /> _ ��0 � l� � � l�', (lrw�, �D� I�cX ��I L=�����Tr d�/.a �s�aao � 5� -�a'� � <br /> Owner Mailing Address Cit —T� <br /> Y ZiP Phone��� ��,3 I <br /> wo. h � <br /> S,� h, e ; <br /> Applic2nt Mailing Address City Zip Phone I <br /> DescriSaPropos� iWork �OC�C ri��� .I /;I'(+ T� �y'jN•�- ���1' ��'/J ����� "rCi <br /> ;�/'.0� � �� r � �� ���,�A�rQS 'r <br /> r <br /> _ /� =<' _/>,P. E � /23�"�/�L S E __ �.. <br /> Project Address(if known) �j`�/�� �� .1 �_s i �y�' � d��, ^,,�r p�„� � <br /> � � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: — <br /> • Propertv Lines ! Centerline ol slreet � <br /> • Outline and dimensions of all existin�and • Indicate North <br /> proposed shucturec on the lot • Show any proposed grading chanc�es <br /> e Ezisti�� and propnsed Wilities O Show measuremenis -_r <br /> DO NOT WRITE BELOW TF!I.i LINC- �i� <br /> � ' <br /> PERMIT CONDITIONS i <br /> 1. All calls for inopedion shall be made 24 hrs. in advance- phone 259-881$. � j <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction I <br /> Standards and Speciticaliona ; <br /> . 3. Call Location Underyround Service 4A hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. � ' <br /> [� �(/� �S� ���ff'FSsd.G� TEi+7�C/'d2� �.rC�SiC/t//SEl�iniE%vTdTia� <br /> �'oNT.eo L Tp BE �oit/E /15 Di.�r�i F!� ,�� ���y �� � <br /> �vFi'FTr- �L�/3Ci! L�cJO.C'.C'S' Z�/S�C�-j0�, � <br /> /"t E1l�. PjG)I011 Ct. � � S��iMPn7 �/A � � <br /> v �")"I.0 � C2',,. � � <br /> i � - <br /> � f, � <br /> � <br /> L�.'�: cC:a CI:L`ti�(:,��_,�.N,�^ i. �i <br /> -c-�i�..,�• C!-kc<: <br /> ACKNOWLEDGF.MENT OF CONDITIONS <br /> _ T�e unclersi�ncd owner/�pplicant hereby agrees lo hold end save harnr <br /> __ — less Ihe City of Everetl irom any and all claims for damages, cosis, <br /> r��'�"�-.' expenses, or causes ol action ihat may arise because of installafion <br /> j ;j�%. 7_a 5/,TS and maintenance of the improvement or other right-ol-way use hereto <br /> ��� applied for and further a rees to remove ^,ame u on noticc Irom the <br /> Approved (o C6n , uction Date City and to replace publio property damaged thereby. <br /> �- r ���� � , <br /> FINAL INSPECTION Date `���' � �� '�"�y-�� _�_;�-,j� <br /> Approved as Construct d SignaWre of Applicant p,��� <br /> everett PUBLIC WORKS DEPARTM[NT �✓ORk AUTHORIZED BY THIS FERMIT MUST BE STARTFD WITHIIJ <br /> � 3200CedarSireet �80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 B[ DILI,ENTLY PURSUED TO COMPLETION. THIS PERMI` MAY BE <br /> Phone: 259-8815 CANCELLED 8Y THE CITY UPON ANY STOPPAGE �JF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> I <br />