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1...I 'i. r� 1..iin�l <br /> Date., ,I / /;'�'1�'.�- - <br /> ,���,,, ��..,., . _�"�7� —�� — <br /> npphwtion Fn� <br /> PUBLIC WORKS PERMIT `'°`�'�o,e���a`�� s. — <br /> n�z�enP� r.xvn�a S — <br /> n,i.�„��.n„ S <br /> Print or Type Only <br /> `����'H/�I2L`� l n'�,C� ��1�� /��l�E.� C:rJ�-^���Fl `�&�D/ �-C�37 <br /> Owner MailmgAdAress Cny Zip Phone <br /> Fa/F�Cfi .I�.l� 5�/Y,� � �G7 .�l l��#t1----�2/Y-� ��?,-�l�l <br /> Appllcant Ma�ling Address Cd� Zip Phone <br /> Describe Proposad Work /"f� r �(J�l -- -- <br /> — � <br /> Prolect Address(il knownl �y,�'�J��� -- � <br /> Allech lour(A) copies ol plans lar p�oposed werk� Draw to scale and nole ihe lollowing as app6c�ble� � <br /> • ProDerty Linas • CenteAine ol sireet � <br /> • Outline and dimensions ol all existing and • Indlcale North <br /> proposed slructwes on Ihe lot • Show any proposed gradmg chan9es <br /> • Existing end pwposed utilities • Show measurements M <br /> W <br /> DO NOT WRI'fE BELOW THIS I_INE O <br /> PERMIT CONDITIONS <br /> t. All calls lo•+nspectlon shall be made 24 hrs. in advance� phune 259•8815. � <br /> 2. All work shell ta perlormed in accerdance with�his permit and current City of Everett Desiyn and Conslruction <br /> Slandards end SNecifications. <br /> 3. Cnll localion Underground Service 48 his. befor�:you dig TOLL FREE NUMBER 1•800-424-5555. � <br /> � � � <br /> �� i.��,�/( � / �i'� ' l. ; � . , . �- �i . . � - �.'' . / <br /> ,7 <br /> �' —�-. ' � <br /> � <br /> '�'��� tn <br /> , <br /> O <br /> a <br /> AChN06VLF::DG[MENT OF-(,ONDITIONS <br /> ThF�undcrsic7ned ownevanPlm.�n�h�reby agree!s�o hold and save harm- <br /> --------- -- � ------- --- ----- ---� tr�ss the City ol Fverett trom any and all claims lor damages, cosls, <br /> �,.pF•nses, or causes ol adion thal may arisa because ol installation <br /> ;ird mainlr.nanr,e ol �he improvemenl or other ri<�hPobway use here�o <br /> ,ippin�d Im ond luriher a�pees in �cinove same uPon notice I�om Iho <br /> Appmvetl lo�Con5lruCtion Dale GitY�����I lo nq,l,�ru P��blir. PruPnrty dama9rd IhPreby <br /> _ ___. <br /> FINALINSPECTION Date _.._--.. . ____._. _----_–. -- -- ------ <br /> Approved asConstructed S�9naiure of �ppl���nni ���P <br /> WOHK AUTHORIZ[� DY THIS PEPMIi IdUST BE STARTED WITHIN <br /> ����e�� PUBUC WOP'"3DEPAFTMENT I80 DAYS OF DATE PERMIT IS ISSUED AND iHEREAFTER I� TO <br /> � 3200 Cedar St�eet BE DIUGENtLv PURSUED TO COMPLETION. THIS PERMIi MAV BE <br /> Eve�elt. WA 98201 C�NCELLCD PY T NE GTV UPON ANV STOPPAG[ OF WORK OtJ THIS <br /> Phone,�. 259�8815 � p�p�F�:T C)Vf R 90 DAVS DURATION <br />