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- <br /> _ , <br /> oate�f 1' ,' P„h�,�wo,��P«,m��. . 9S� J _ <br /> Bl�q pep�.s _.__ <br /> � ' � <br /> Applica�ion For �^ <br /> r' <br /> . � PUBLIC WORKS PERMIT R °°'�:o�;Fee`°° $_ — <br /> r� <br /> Less noni F?e P,aid S__�__ <br /> o a C Bri,,�c�o,�� 5��r <br /> Print or Type Only <br /> �; � � pOZ-•32Z�j/o//63/ <br /> � <br /> l//:.��,�,���[��p,�k��n lr��iu� ��r�o M�vl��.�* �u�bt <br /> �w�Pi� \+lai�in�;�r:Jri+ss Ni7 rn � 3. ��� �� P,,,_ � ho�„w�� <br /> N O �"� C ��� <br /> � `� � C'. ��Z� ��'2'�� <br /> �� �rLl__�C"._�a���-----g� - -- <br /> ApplicaM htc�lm:;Addre.ss C�ty Zip Phone <br /> Describe Proposed Work ��-�----�(-�-�---CJ�'^-+^'—'—��G-`—���'�r'—`--- <br /> -/�o, �—Ic-sta�r�--- ----- W <br /> Project Address�if known; �_/ �-- --- --- — � <br /> A�faGh fOur(4) COP�eS of Plans loi PropuSeJ work - Drav: t. >�:dL. .in..� nole ihe'onuwiny as anUlir.able: � <br /> • Properry Lines • CeMe�linr. nf atreet � <br /> • Outline and dimenslons ol ali e■isLng and • I�•�tlicatc Norlh <br /> proposed structures on Ihe lot • Sho��any r,ropesed e�rading r.hanues <br /> �. � Existing and proposed utilflie5 • Sho�v measurements M <br /> W <br /> DO NOT WRITE 8[LOW THiS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calis 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 wrrent City of Everett Design and Constructiun <br /> � Standards and Specifications. <br /> 3.Coll Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEPAENT OF CONDITIONS <br /> Thr under��aned owner/aPPl�cant nereby agrees to hold and save harm• <br /> --" '—"� less Ihe Cdy or Everet� irom any and all daims for dama9es. costs. <br /> �� i e*penses. o� causes ol action that may ans? because ol installation <br /> ------�-��4%�� Q �S � I and �naint anr.c o! ihe imProvemenl or other ri9ht�ol•way use hereto <br /> �GlIF/ l I ;�;,pt��,t 1 r a� further agrees lo remove same upon notice irom Ihe <br /> Approved for Construc ion Daia � ��� ❑n�f m repl, ce Vubhc p�onerty damaged Ihereby. <br /> � <br /> ��-__ r��� � <br /> FINAL INSPECTION ��« � ' • Date <br /> Approved as Constructed �c tu I ppli ai . <br /> WO . UTI�ORIZF'' BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��r� PUBLIC WORKS DEPARTMENT 80 D S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet B GENTLI' PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Everett,WA 98201 GANCEILED 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-887Q i pROJECT OVER 90 DAVS DURATION. <br />