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a <br /> � �. <br /> �ece s�s 8� / <br /> PUGuc Worka Permit♦ ���— Ztp� <br /> ApplicalfonFor BIap.Depts_ �/A /�//e/l�j <br /> PUBLIC WORKS PERMIT '�°To,�eeFee s <br /> Lea�Rpp�_Fee PeiE S <br /> Print or Type Only n.�.��,o�� s 35 00 <br /> PlfL�/P ht, ESTEP �83� Ruc,��R AU� F✓�R�� 48.zo/ / �u�o y <br /> Ownrr Mailmg qdtlress <br /> City Zi� Phone <br /> SAirt F <br /> Applicant Mailing Address �i�Y Zi <br /> p Phone <br /> Describe Propose Work /2, Q�� <br /> r <br /> .�O <br /> Project Address(il known) 3�'7'�'"� /,/i � <br /> v�i �Attacn lour(4)copies oi plans for proposed work- Draw to scale a�d note the following as applicable: <br /> • Property Lines • Cen�erline ot street <br /> • Outline and dimensions ol all existing and • Indicate North � <br /> Pr�posetl structures on ihe lot • Show an <br /> • Ei,isting and proposed utilities Y Proposed grading c�anges <br /> • Sl�ow measurements <br /> � <br /> DO NOT WRITE BELOW THIS LINE � <br /> P[RMIT CONDITIONS O <br /> 1. All calis for inspection shell be made 24 hrs.in ativance• phone 259•887$. <br /> 2. All work shall be pertormed in accordance with this permit antl current City of Everelf Desig�and Construction ' <br /> Stantlards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> 7 9��j�iGi9.✓T' /.F i� /'��'O✓ipE' /f ?E.C'Fo�ii�.9ir/C E Z <br /> �Yi�4�P.fk/Tf/ fai2 Ti✓� �P .PE�Ci/.eED SiDEc✓f,�[ �C" O `! <br /> IysTf�c t f�iia/✓. � <br /> S ZSTAcG .[7.c�itiF.�i9J/.r �i2 CiT3/ SiA.v0.9.et7 �°`307 - �I/ <br /> CU�B,S,rior Tv BE� ,�„�,�,�..o Ofiu'- SEE ,9�'iyCiyE� NOT6, O <br /> Ar Ti✓E ovi.vF.�s _.os�no.v ._ Acc Ey BF.,�.,vv p,�a.�osEo � <br /> BG�iG�i.rlG P,v.�Ev c.i.r.r .9.r.o.v9tT PE.e CiTy SY9.vOtlaO'�' �'03. <br /> ZtiS�'9tG 4B. 7y�:9'.9S NEtFSS.9iz�. f+,vo Ca.vyEcT T� Cd ,p� ;yE <br /> .VH! GY��CNE.G Of ��E 9CCEf/. C/IL[ io.c'L✓Jf? ACKNOWLEDGEMENT OF CONDITIONS <br /> �EFOK'E .BEGi.�-v�'��c% L�/O�c�C The undersigned owner/applicant hereby agrees to hold anG save harm- <br /> less the City of Everett Irom any and all ciaims for tlamages, c�sis, <br /> .���i / � expenses, or causes ol action Ihat may arise 6ecause of installation <br /> �.L� ��8�� and maintenance ol Ihe improvement or other right-ol-way use hereto <br /> Approved�or Construction a�e app!ir.d for and furiher agrees lo remove same upon nolice Irom ihe <br /> City and to icp�ace public property damaged Ihereby. <br /> ��� //1i �C C <br /> FiRh'( INSPECTION Date � � i C�� 4� S g <br /> >pproved as Constructed SignaWre o^pplicant � <br /> Dala <br /> everett PUBLIC WORKS DEPARTMENT WORK AU C�RIZED BY THIS PERMIT MUS7 BE STAqTEG Wi�i;;^! <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND TI+EREAFTFR IS 7p <br /> Everet4 WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT IdqV gE <br /> � Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGG OF WGFR ON THIS <br /> PfiO,IECT OVER 90 DAYS DURATION. <br />