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i <br /> Date�L���0 � Pub�¢IVorks Permit• `'� — 2 7 � <br /> 7 ' <br /> Application For eiae oeoi.+ �-O�y <br /> PUBLIC WORKS PERMIT PuoucWorwsFeo — <br /> Total Fee s <br /> Less ApPI Fee Paia S <br /> � — '� Balance Oue S S�p� � <br /> Print or Type Oniy I (� � � — � <br /> Gny�,i�D/�.r�,7� / ��?,l�c I/�! 7 �✓n,�� 9d`2n6 Zs�',� 3or� <br /> Owner Mailing Address Cdy 2ip ��hone <br /> �� llPn Crv��t' /�7/Sdx Qq7n 5�,���(� �2�z - �77� <br /> Applicant • Mailing Atldress City Zip ' ' hone <br /> DescribeProposedWork I�/�i�) �aCai7,..� �+.n,.��?...!' ��f0 . , "� <br /> �rt �b��i2r'- <br /> � O.�%c�s 8c��cO�.vcr o.vt�- �.�r�o�- .e,�� v��,E r�A,P,tiar�- •SLi�i1A <br /> Project Adtlress(i(known� /32/ — �'aLd��v�_ W <br /> � H <br /> Attach four(4)copies of plans for proposed work- Draw te scale and note the following as applica6le: � <br /> � Properry Lines • Centedine oi street � <br /> • Outline and dimensions of all existing and • Indicate North � i <br /> propos�d structures on�he lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � � <br /> DO NOT WRI'E BELOW THIS LINE F <br /> O S <br /> PERMIT CONDITIONS � <br /> 1.A l l c a l i s f o r i n s p e c t i o n s h a l l b e m a d e 2 4 hr s.in a dvance•�:hone 2 5 9•8 8 1 0. � ; <br /> 2.All work shall be peAormed in accordance with this permi!and current City of Everett Design and Construction <br /> Stendards and Specifications. <br /> 3.Call Location Underground Service 4B nrs.betore you di4�.TOIL FREE NUMBER 1-800-424-5555. � j <br /> � SG�i L�102..E. � ,l�C O�QXy �Qt/L [i� :�02na. O . <br /> �..� <br /> do-� 7 7 88 ��orc ,o.vy ��ok.r SHo��,v �,d SrrF <br /> /�C,9.✓ �ILa.✓C• /frMsy lrAy .c/E�i,7 Tv 6'� novUi�iEO To � <br /> �LGOq,/ FoK LL i0?.waNG of /�f f'f�� <br /> � 0lV��/L ifiJ j�/fOlr�Lb'U �..Q�st+z-C.c� �f.�t�a�4 ���'v � <br /> J.ciucc-� �llt�-.v�w� � T�,,,S�f �Or�+� IOCa,�f � GY�Oaa[U O <br /> /n. � Q.r.so-v� a ' � /f��004 v � � <br /> �L DoNF 7-it3 88 <br /> �o, Ow��c� �r -ac�ll-�iu.�lGrc.i- �Co�i e£G�e.c7� .a,�e�t.�,..�.a� ow /5��'.J.x <br /> T _�, cc�l� �� �,�,� ,c�:-, fs� oct is� i988 <br /> l <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneqapplicant hereby agrees to hold and save harm• <br /> less Ihe City ol Everett Irom tny and all daims for damages, wsis, <br /> � expenses, or causes ol aclion that may arise because oi installatien <br /> �j�(/�,� J�j�.. .�f�� ���_�g and maintenance ol the improvement or other right�ol�way use hereto <br /> Approved for Construction applied lor and lurther a�rees to remove same upon notice Irom ihe <br /> / Oate City and to,r place public property damaged thereby. <br /> - � �`'� - / <br /> ����-�-�.- = ��, 2t � <br /> l IN�PECTION �� Date % � ' . � <br /> Approved as Constructed LS�gnaturo of Ap icant ��ate <br /> everett PUBLIC WORKS DEPARTMENT WOflK AUTHO IZED BY THIS PEflM f MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AhD THEREAFTER IS TO <br /> Everett.WA 9820� BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY TI1E CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURPTION. <br />