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� i. <br /> ( <br /> i <br /> I . � <br /> � '':1 <br /> 1 <br /> � <br /> i ' <br /> i -i� <br /> i <br /> Datc ��}p' ,Qf� /8,� <br /> / " � Puphc Works Pe:mi�1 a"pv,- � <br /> Application Fo� ein�� ocn�.+_SCo��p,.� <br /> �'{d M�l� •■ V'��\y ��, i� '� f���iic Works Fce ' <br /> To�al Pec g <br /> Lru FpPI.Fec Pald cu <br /> F'firlt (:f T)/�19 Ofl�)/ Ba�ancc0uc 5 ��G�— <br /> —�a,a�csn���„� �, ��,,, �� � ! u � �l �P /DI� /X� D zs3� - �' RO <br /> Owner.J MailmgAddress Gty 2iG / Phonr. <br /> _ Cf7 Wt- '� <br /> ApU��car.t Maili�g Address City Zip Phone <br /> 1 <br /> Descrihe F'rcpos?d Work �(�(A��`Jn � ! �V � (�/1 <br /> --- L a f 7 �,r��rr„ � (`�,�� ('—�°� <br /> ?rojec!Adtlress(il known) �.J��L— ���-~--�ry(�P. �, � <br /> Attach four(4) copies of plans for proposed work- Draw to sczle and note the(ollowing as applicable: � <br /> • Proprrty Lines • Centerline of street � <br /> • Outline and dimensions o1 all existing and • Indicate Nor�h <br /> proposed structures on the lot • Show any proposed grading changes <br /> ! Existing and proposed utilities • dhow measurements <br /> DO NOT WR!TE BELO'N THIS LIN[ /�� <br /> PERMITCONDITIONS [ ) <br /> 1.All calls(or inspeciion shall be made 24 hrs.in advance-phone 259-$$10. ��� <br /> 2.Al;wo�k shall be pedormed in accordance with this permii and current City ol Everett Design and Construciion � <br /> Standards and Specifications. <br /> 3.Cail location Underground Scrvice A� his.before you dig.TOLL FREE NUMBER 1 •8U0-424-5555. <br /> i� <br /> � I I <br /> ! p <br /> �V/ <br /> � <br /> � <br /> � I <br /> �� � ACKNJWLFDGEMENT OF CONDITIONS <br /> � _ _ The undersigned owner/applic�nl hcreby agiees to hold ar,d save harm- <br /> � less the City of Everett M1om any and all claims lor damagas, costs, <br /> � axpenses. or causes ol action Ihat mny arise because of installation <br /> l/J J � � �_„ L� �C� Gi7 and m.aintenance of Ihe improvement or olher ri hbof-way use hereto <br /> Approved fcr Const � ion � 1 a�P� �P��ied for and further agrees to remove same u�on notice Irom �he <br /> City and to replace pullic prop y dama jed ihereby <br /> � Y`-��' �/ � <br /> % <br /> FINAL INSPECTION Date i / � �'" <br /> Approved as Construc�ed igna�ute of Applicant Datc <br /> everet[ PUBLICWORKSDEPARTMENT WORK AUTHORIZED 6Y THIS PERIAIT MUST „E STARTEG WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER iS TO <br /> Everetl,WA g8201 BE DILIGENTLY PURSUED TO COMF'LETION. THIS PERMIT MAY �G <br /> Phone: 259�8810 CANCELLED BY THE CITY'UPON ANY STOPPAGE OF VJORK OtJ THIS <br /> PFOJ[CT OV[R 90 pA}'S �UR:�110tJ. <br />