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111N.Work,Permit e ✓T—Jyz <br /> Application For mdg Dept.e <br /> PUBLIC WORKS PERMIT rmkwmxeree <br /> Intel fee S <br /> t.rss Appl Fee NO S <br /> nNenne Due "— <br /> Print or Type Only <br /> i <br /> reAyj 7g32 Clic R � Gunrze# qr&?t '' <br /> Owner Mailing Address City Zip Phone I <br /> �r �t <br /> CAL" urfiz 2(1?3L i�,/Ake-{- <br /> Applicant Mailing Address Clly Zip Phone <br /> Describe Proposed Work J )I L 0[n, _ <br /> i <br /> -- - W <br /> Project Address(if known) :M'S'7 UPEW Tzmar 9M, .-- <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and 41mansions of all existing and 0 Indicate North CD <br /> proposed structures on the lot • Show any proposed grading changes <br /> 0 Existing and proposed utilities • Show measurements Go <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for Inspection shall be made 24 hrs. in advance•phone 259-8815. <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hre. before you dig.TOLL FREE NUMBER 1.800.424.5555. z <br /> y le GTi9/�e�i<•e Cavc.Gtr3�- drPiuc�/cA9/ TILE <br /> --- (,v/lL AE ,PEdvdpfEb /f 0,61f IX IX To BE <br /> /,V_(,roWGE,0 /AIA 4,nVI SEeTiO� <br /> rf/JPsex-o.d eW 7W W/GG 6v <br /> t`�Q vi etf o BEFo eE /r /s oov Ei�Fp <br /> zoo ez sAoka C 9E /N coy» Yi Save' cJ�r� I ; O <br /> �SECT.Iryt/ SI, //. 2 Of TNS F✓ PES c . ILC <br /> 0 <br /> _)f-,pe 04- ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the Improvement or they right-of-way use hereto <br /> apple <br /> for end further age to remov, same upon notice from the <br /> Appro, Conatruclion� Date Clty a to replace p bile r meg d thereby. <br /> FINAL FINALINSPECT10 —��f Date <br /> Approved as Constructed nature of Applicant- <br /> PUBLIC <br /> pplican ate <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Ceder Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BF' <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON <br /> everett T- <br /> Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. <br />