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Date ��L.'�� <br /> ,��,,�,�w�,.,��a,m„. �3 /�3 <br /> f��a� oen� � —6� �� <br /> AUD�i����on For <br /> PUBLIC WORKS PERMIT Pu[i¢Wpd�iae s ao. �o <br /> TotN iee <br /> �� <br /> Les��00�Fee PeiO S--- <br /> BaiencaDuo s��� � � <br /> Print or Type Only � �.3(;!s�r <br /> .y ���;�i�',� L ���A�',6'�'.E'�' ,l� FI/�RE�i �r�„s �.�".� 7Q�Z_ <br /> Owner Maihn{�.Address City Zlp Phone <br /> .`.�Cl►N Q <br /> Applicant Meilini�Adtlress City Zip Phone <br /> � y(' �('�7� �.f'rf!'�� (�/".'l'f� /•"�;�1`'t��ti!;(,' . 11.�.�1�' — <br /> Descrlbe Proposed Work .,.1��r�--- - >-""- <br /> _/ �9-�-��p�- -------- _ 1.6J <br /> Prolecl Address(il known� ._ — � <br /> Atlech lour(4)roV��es of plans for Uroposed work� Orew to scale nnd notc the'ollowmy as epplirable�. � <br /> • Froperty Linas • Centurlino o'sheet � <br /> • Outline and dinensions of all ezisting and • Indicete North <br /> proposed s�ruclures on tha lot • Show any proposed g�ading r,hanget, <br /> • Existing and proposed utillties • Show measurements M <br /> W <br /> �� 00 NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspAction shall be made 24 hrs. in advance� phone 259•88�5. �\ <br /> 2. All wo�k shall be peric�med in accordance wilh Ihis permil and current City ol Everett Des gn end Construdion ♦ <br /> Standards nnd Spncilications. <br /> 3. Call Locnlion Undarqround Service 48 hrs. befuc you Aig. TOLL FREE NUMBER 7-8�0•�{24•5b55. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> nCKNOWLEDGEMENT OF CONOITIONS <br /> Th?unAers�yned ownar/applic�nt he�. liy egreas lo hold end save harm� <br /> less iY;e City ol F.verelt from any and all cluims lor demeges, costs, <br /> `��-�-s expenses. v causes ol aclion ihal may erise because of inalalletion <br /> �_�j_ 3.3 and maintenance of tY�e improvement or other right-obwey usa hereto <br /> epplied for end IuAher agrees to remo�e s»me upon notice irom Ihc <br /> pproved lor Conslruction �e�e City and lo replace public prono�ry tlamafl�'� thernby. <br /> ��I� � z � � / /�� � � <br /> . �,.- �, �_ <br /> _ , <br /> FINPIINSPEC(ION —L�`Oate 1Llr,-T � l"�R[* . „;;�'( _ <br /> Approved as CJnsiructed � SiBnalutC o�ApPI¢ant DHte <br /> WORK �UTHORIZED �V THIS PEFMIT MUST BE SiARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS Of DATE PEPMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cadnr Street BE DILIGENTL" P��ASUED TO COMPLETION. THIS PERMIT MAY BE <br /> Ev2rrti, WA 98201 CANCfLLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> f'Ihone� 259-8815 f'ROJ[CT JVLH 90 DAVS DURA710N. <br />