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Z-�7-g7 _ . <br /> Date ��SL <br /> PuEI¢Works Permil• <br /> � r <br /> �� � AppliCation For eiop.Deo� • n � � �� � %1 <br /> , PUBLIC WORKS PERIIfiIT PueTo:alPoeFee S <br /> ' _ :ev Appl Fee Pe�a S <br /> � Print or Type Only oeia�ceo�e S /"� IH��Yr' <br /> I <br /> I ' . / <br /> : ��, rn��iav5 For�ha� ll���Y / �� Rrro,✓ �u-t�h` 9��Zo/ <br /> � Owner Mailing Address �� Ctly Z�p Phone <br /> I C7��y�irv� !l�s7r�talif�n5 /li�L� � c%�K�en.�57� /ltY7/�mp' /SlOS� � �f�-��� <br /> i <br /> � Apphcant / Mailin9 Atldress Cit <br /> Y Z�P Phone <br /> I Describe Proposed Work � � �T �j rn 'y» / �,� r �Z1,�� 1��� �/ � <br /> I tr �— <br /> Prulect Address(if known) ����� — �/OAp��,�y� � <br /> i �Attach lour(4)copies of plans lor proposed work- Draw to scale aod note the lollowing as applicable: � <br /> • Properry Lines • Centerline ol sireet � <br /> I • Outline anJ dimensions of all existing and • Indicate �'orih <br /> proposed slructures on Ihe�ot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> I DO NOT WRITE BELOW THIS LINE � <br />. i PEfiM1T CONDITICNS O <br /> 1. All calls(or inspection shall be made 24 hrs. in advance� phone 259-A81 5. .� <br /> � 2. All work shall be per(ormed in accordance with�his permit and current City of Everetl Design and Construction <br /> Sizndards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> '� /�",�/<�C9.vT /S Tc- l'oi,?<:�T T�isr ci.r/ � <br /> Ti.^� . l��i- '/_ ('(�-:,�(:-� i� .. <- --u . . .. O <br /> � �i i ,.J. ,. , - / �.:. l ��/::.:/._ <br /> i <br /> � O� T/= :in= . . 'i��� l � <br /> �i <br /> O <br /> II <br /> a <br /> �I ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees�o hold and save harm� <br /> I less the City of Everett Irom any and all cla:ms for damages, costs, <br /> i expenses, or causes ol action that may arise because of installation <br /> �— / _ i� ; -�nd maintenance ol ihe improvement or other right�obway use hereto <br /> ./, �� �-r.:.�.-_ � <br /> I Approved for�Construction applied for and further agrees to iemove same upon notice Irom the <br /> Date y p p y ged Ihereby. <br /> i Cil and to re lace ublic ropert da <br /> I� ____—�� ��� � <br /> FINAL INSPECTION Date L �vl �) j ' y g � <br />� Apprnved as Constructed Signat re ol Applicant Date <br /> I evereu PUBLIC WORKS DEPAFTMENT WORK UTHORIZfD 8Y THIS PERMIT MUST BE ARTED WITHIN <br />. � 3200 Cedar Streel 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett'�1�A 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> i Phone:259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />