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.\ <br /> Date����� c�ei�c wons ve.mn• � � 7 ^ � <br /> AppliCatiOn For B�aB-DeO�-• <br /> PUBLIC WORKS P�RMIT P°°ro,:FeeFee S <br /> Le:s aoo�.Fee Paio S <br /> e.i.��e o�� s <br /> 3S `'` <br /> Print or Type Only <br /> oaz-,3zzvo�i83/ <br /> ON�ner MaiFng Address Clry 2ip Phone <br /> �,AYc�IE � 1�X1'�1 iY� Z°tl1 � d�� �� W� �18�1 �2�-211� <br /> Hpplicant Mailing Address City Zip Phone <br /> l`� 'r�1,�� �{�� ' (s ' <br /> Dastrib1a Propos d Work � <br /> l �� <br /> Q W <br /> Project Address(it known) ✓ � � <br /> Attach four(4) copies of plans for proposed work• Draw to..cale and note the lollowing as applicable: � <br /> • Property Lines • Centeriine of street � <br /> • Outline and A'mPnsions ot all existing and • Indicate Norih <br /> proposed structures on the lot � Show any proposed grading changes <br /> i ExisUng and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIOhS <br /> . 1.All calls for inepection ahell be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shell be performed in accordance with this permit and curtent Cily of Everett Design end Construclion <br /> � StanderdsandSpeclficalions. <br /> 3.Cali�_ocation Underpround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> /. /lGCSG»� yj '�t��" QG 2 �h'i*q't,vn-ru�n�- � a� //L-('"214- O / ��./"'�`-c,[ O <br /> �"CtiP/s— ✓� 7 �r LGv��� .�JOG�C.-, � <br /> .,�� �a� � d�a.�„ ,�, -e1a.f�-.:y .�'rt�e/ �.c.c�-��• �/� <br /> O �/I <br /> �, w�..� � �- dm,.L.�2 ��,� �� �� a <br /> �,G�A�"'�'C/ �"U""_-- - CY`- O�� ��r,�„� "-cilG�J <br /> �`_�•� r <br /> ' ACKNOWLEDGEMENT OF GONDITIONS <br /> � The undersigned owr,er/applicant hereby agrees to hold and save harm� <br /> less Ihe City of Evereu from any and all claims tor damages, costs, <br /> � // expenses, or causes of action that may arise because of installa�ion <br /> ,�X• / Q /l�— O�� /9 j and maintenance of the improvement or other right-ohway use hereto <br /> %112t A-i�ro! d // applied for and further agrees to remove same upon notice irom the <br /> Approved for Con�f n �� a�e City and to replace public property damaged thereby. <br /> --___s���' �>— i�.�- s3 � & (o • 3 <br /> FINAf_ INSPECTION Date <br /> Approved as Constiuded igna re of Applicant Date <br /> PUBLICWORK3DEPARTMENT OR AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��� 3200CedarStreet 1 AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> '�rF» Everett,WA 98201 BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERM�T MAY BE <br /> �r,� CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 pqOJECT OVER 90 DAVS DURATION. <br />