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�_� ,��.� <br />�;:' - <br />�„ <br />�,. . <br />� , <br />��.� <br /> ,���.{'I, _ <br /> � <br /> _ ' ; <br /> � .0 5 �s�k <br /> a „ PuoLc Woiks Pennil a __ <br /> ��� Applir,ation For oiaq.oep�.�_ .��__ <br /> PiJ�LI� WORf�S PE�iP�iiiT P°°ro,WF�=F�o � — —_ <br /> �ess nnoi.Fee aam S <br /> Print or Type Only Ba1anCe,�� � zO�10 <br /> i,��G+��=c� ,3�I� n���K � �T c o r�.c t u, ��-� o a 3 ss-s �i y <br /> Owner Mailing Address Cify Zip Phone <br /> S R y�-� � <br /> Applicant Mailing Address City 7ip Phone <br /> Describe ProPosed Work (,.�,ti��l.[ �/�vL�/��-�l�s^ / �� / . , (/�i �/j,�y,t2,/ <br /> i <br /> I_ <br /> - � Gor a3 vF � <br /> Project .4ddress(it known) — _ � <br /> � r.�/ !i'/c G- �!f <br /> A��ach four(4) copies ot plans tor proposed work- Draw to scale and note ihe lollowing as appGcable: S �� <br /> • Property lines • Centerline of sUr.et � <br /> i Outlim:and din,ensions o(ail existing and O Indicate North <br /> proposed strudures on the lot • Show any proposed grading chanqes <br /> ! cxisting and proposed u�ilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calis tor inspeClion shall be made 24 hrs. in advance- phone 2S9•8$�5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design ��.nd Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before ycu dig.TOLL FREE NUMBER 1•800-4�4-5555. � <br /> � <br /> � <br /> � <br /> � , <br /> � <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> The undersigned ownei�applicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett irom any and all claims lor damages. cosls, <br /> � expenses, or causes of actio�i ihal may arise because of installation <br /> ,p.(�/ c_- � _ ,� f, �t; , �/E �� and maiNenance of the impro�ement or other rghl�obway use hereto <br /> U� Zl�l !T> applied lor and furt�ier agrees o remove same upon notice irom the <br /> Pprove� d tor Consiruction — / Da�e City and Ie replace pub!ic prope,ty damaged ihereby. _ <br /> �/ il � <br /> �YY�� ~ "� � .�C�'`Gl� L�-�`C"� .7 '/ <br /> FINAL INSPECTION �/ Dale ` /�L <br /> Approved as Constructe /\ SignaWre of Applicanl Date <br /> �J WORK AUTHORIZED BY THIS PC-RMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERh11T MAY BE <br /> Fverett,WA 9A::01 CANCELLED BY THE GTY UPON ANY�TOPPAGE OF WORK ON THIS <br /> Phone: 259�6;15 PROJEr,T OVER 90 DAYS DURATION. <br /> �� <br />