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���i y_ / <br /> Pu�l¢WorFs Permil• ��_/7/ <br /> Application For aioa�o�o�.• <br /> Pl,9BLIC WORKS P�RMlT PuoTotaFeeFec $ ��S-= <br /> LC59 ApO�ree Pa�O � <br /> � —�_ <br /> Print or Type bnly aa�o��Bo�� S =�_S <br /> 9y.ss� <br /> � .�_r <br /> G'J/�j � �'�6C�S'.T ScclT�= /J.7 / �>/ 5/ -si= .CGt.F'C-i�' <br /> Owner Mailing Add�ess City Zip Phone <br /> G�1�r'- !'�"�'�2 c7� <br /> — `'S�/�jF—' �.5 l'— -��' '� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work L[J/��� �'o<.[S�/� �O��l�ca� c2§'� /C9 � T�- <br /> T/� Svzi T.�/_ <br /> �I T � <br /> Prolect Address(il known) /�+020 — �/ — _ � �L�,«.� � <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline nt sireet � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> pioposed structures on the lot • Show any proposed gratling changes <br /> • Existing and proposetl utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permrt and current City of Everett Design and Construction �r <br /> Standards and Specificatior�s. <br /> 3. Call Localion Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•800-424•555$. � <br /> y 2J,P/o"��Gv�j� w�OciJ rc� ST�J_ ,�J7 s.?cJ c'uT oF ��fi.Pr�•r�'-� <br /> SiOr4i,Ac/L� � Ccl�.6� �cyOrri.F4�o_ /C>� GJ�OTirf /�dyl/Tlc,� i'ro � <br /> �X/T�0 j�? Sc�7lT/� G+"i!J COG.p'� <br /> �•. C���C���//��i- �/��I+��c/�7�� �C/� iV/f��/1�.L+ C�Gi/�/ � <br /> / �/��n�sJ/i�v c^'�cF'T �jF',�,�'p/�Le ���� c,c?Scc.;Pc <br /> �c/IICc' �'_�tt�.ecTe.) o iil .s��uTjy /�.�'c9?iP7'J/ <in2-�„ � <br /> ��� ST/,r'z�.o����� F<cG?i'To/1� J�/Fit'c /� <br /> �c"7✓�C`c�' a iJ S vz�ii j� W <br /> f'�vfr,E'� {ii�� <br /> �? ��('.?��cr- �i��-r=-:E'�,.Cs' v�J s�r.� � .�till.oi�J v�l�%f�iP�t)cs�? <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant heraby agrees to hold and save harm- <br /> less ihe City of Everett from any and all clalms for damages, costs, <br /> �� expenses, or causes of action that may arise because ot installation <br /> _ �� and maintenance of �he improvement or other righFol-way use hereto <br /> Approved tor C6nstruclion Date applied for and further agrees to remove same upon notice Irom the <br /> C City o re lac erblic per am reby. <br /> -�— � � <br />� ' �'-��% ��l/�'C ;' l � <br /> FINA�f S CTION Data <br /> Approved as Consiructed �31 a! � o pplicant �� ate <br /> evereu PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERtv11T MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WFl 58207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�F361 5 CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS <br /> PROJECT OVER 90 D,4YS DURATIGN. <br /> L <br />