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� <br /> Date // 8 <br /> PUEIic Works Permit• �S—z/7 <br /> � Application For Bioe�oeo�.• <br /> PUBLIC WORKS PERMIT <br /> Pu01¢Works Fee <br /> Totel Fee S <br /> Print or Type Only �a=sAooi.Fe«ae�a s <br /> . eaiencaoue S/UO Cy��,C' � <br /> Ra 'N`�-� ��'� k- C-OJz- � Un�on . Sc«.-j-/�.� Lc�o_. <br /> Owner Mailing Address <br /> �ty ZiP Phone <br /> cSC�V . � � / � �o`�j S, C�� �G2 -b'833 <br /> vt�7�✓ E . �11L —�C�- �e�r��..le S I Ses.-��{. �1�/D� <br /> Appiicant Mailing Address <br /> ���Y Z'p Phone <br /> DeScribePropoSedWork 2e-`�ov�...'�� f..'7Gfgvlor� $ p-{.�'/ f-5 � ,-e�n� <br /> LoG��cc� �.T / Cv2I Cc..J, • -_ ti �� FC.�/ <br /> �orrzi c� Sl. c v <br /> �O �/�, , C4 O GI/✓J <br /> �l�o� �=-iM e ✓t 7� Y�ciC l� u ax��� <br /> �1�----�---�s /�i C�-� Ol��' . <br /> o-,.-} o -E lt � e c.�I � <br /> ` rt�'d> � <br /> Attach fow(4)copies of plans for proposed work- Draw to scale and note th�Ilowing as applicable: � <br /> • Property Lines — <br /> • OuUine and dimensions ol all existing and � Centerline of street � <br /> P�oPosed structures on the lot � Indicate North <br /> • Existing and proposed utilities � Show any proposed grading changes <br /> • Show measuremenis <br /> DO N07 WRITE BELOW THIS LINE � <br /> PERMIT CONDI710N5 O <br /> 1• All calls for inspection shall be made 24 hrs. in advance•phone 259•88�5. <br /> 2. All work shnll be performed in accortlance with Ihis permil and currenl City o1 Everett Design and Construction ' <br /> Standards untl Specifications. <br /> 3. Call Location Underground Service 48 hrs, before you dig.TOLL FREE NUMBER 1•8p0•424•5555. <br /> � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less ihe City ol Everett Irom any and all claims lor damages, costs, <br /> _ �/� / ��/�y� expenses, or causes oi action �hat may arise because ol installation <br /> G��� O��I?� lY � and maintenance oi ihe improvemenl or other �ight-of-way use hereto <br /> App�oved lor p nstruction Date app1ied lor and further agrees to remove same upon notice Irom the <br /> City and to replace public property damaged thereby. <br /> �..�_ /�,/�- <br /> FINAI�I SP 710N <br /> Approved as Constructed � �ate , 7_ /�_pS �� <br /> � na e nl qppliIGran _� � <br /> everett PUBLIC WORKS DEPARTMENT RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar SUeet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA gB201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-BB15 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 UAYS DURATION. <br /> J <br /> L <br />