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i <br /> � <br /> � <br /> i <br /> / � �? — %1 . . �.—.. . . - . . . .. PubiicWorksPermitr 5l \O(p / I� <br /> Date � r � � <br /> i Application For j�^-a oeo�.• <br /> PUBLIC WORKS PERMIT PubTot7FeeFe� $ �o <br /> �ess aoot voe aa�e S ��--- <br /> 9alanca Due $ <br /> Print or Type Only I <br /> L-�a�a F �,vo���r--�I �1�a r<rr►vE � ����=��TT 9�a o i.��_ �sa I <br /> wner ' Mailing Address City Zip Fhone �� <br /> / oY0� ��i R.s�+J �f�<� �-��►� �vE,P� TT ��oi �Sz - StaSa 1�'� <br /> Applicant Mailing Address City Zip Phone <br /> /✓O, ,����..r�;� � ,��� , . <br /> Descrihe Proposed Work ..( "wh� � � — � <br /> `%7�y �_��i�7 �/.I.1/e�.- �9��n7i/ �i'Y ..C�� 3�� <br /> ►—�-- � � � <br /> � � �,r�� /� � W I <br /> ,�/� , <br /> Project Address(if known) —_�L�—���^� ��'�1' ~ <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note ihe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements � <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•8810. � �, <br /> � 2.All work shall be pedormed in accordance with this permit and currenl Ciry of Everett Design and Construction <br /> - Standards and Specifica[ions. <br /> _ 3.Call Location Underground Service 48 hrs.6efore you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> O <br /> ■ <br /> � <br /> O <br /> a <br /> ACKNOWLEOGCMENT OF CONDITIONS � <br /> oK'c� b�j All•,.• I.oc.Kr, <br /> v 3.�_�� The undersiyned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry ol Everetl irom any and all claims for damages, costs. <br /> expenses, or causes ol action that may arise because of installalion <br /> () and maintenance ol the improvement or other right�ol-way use hereto <br /> �CLL-C.. � ��'L�'-- J � ���1 apPlied for and further agrees to remove same upon notice irom lhe <br /> Approved lor ConstrucUon � Date Cily and lo replace public property dama9ed thereby. <br /> �--�� —�— /7'/G � y1 � <br /> FINAL INSPEC%ION Date /^������ �'-!� �7^�---- <br /> Approved as Construcled Sic�nature of Applicant Date <br /> WORK AUTHORIZED 9i THIS PERMIT MUST BE STARTED WITHW �� <br /> everett PUBLICWORhSDEPARTMENT 180 DAYS OF DATE PERN�IT IS ISSUED AND 7HEREAFTER IS TO , <br /> � 3200CedarSlreet BE DILIGENTLY PURSUED Tll COMPLETION. THIS PERMIT MAY BF <br /> Evereil,WA98201 CANCCLLED BY THE CITY UPOfd A.NY STOPPAGE OF WORK ON THI' <br /> Phore:259-8870 PROJECT OV[R 90 DAYS DURATION. <br /> II <br /> � <br /> � <br />