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�'� . . � B6--9so <br />� Date � �� 8� Pu�LCWorksPe�mit• — <br /> eiao oeo��• <br /> Applicatirn For <br /> PUBLIC; WORKS PERMIT '°':�,.F��"° : — <br /> �esenoci.�ce Pe�tl s ;�'S�� <br /> Aeience Due S� <br /> Print or Type Only <br /> ���� 3231 �vr�- '6rao��ax 98201 33Q-�.f/R <br /> Owner Mailing Address Gty Zip Phone <br /> C�own ��,o�ro SYS�s 3z31 �h�o�w'a�/ 9g201 3s� - ��/R <br /> Applicant Mailing Address City 2ip Phone <br /> Jescribe Proposed Work 'r 1 Q� � �� /� � " � ^ �l � G� <br /> �� Tra,a�o�-��i e�f�_ <br /> �7�� W <br /> Project Addresslif known� "`��� `�— 4� � 2 I e � <br /> Attach four(4)copies ol plans for proposed woik- Draw to scale and note the follow g as applic e: �s <br /> • Property Lines � Centerline o eet <br /> • 6utline and dimensions of all existing and • Indiwte Norih i <br /> proposed structures on the lot • Show any proposetl grading changes II <br /> • Existing and proDosed utilities • Show meas�remPnls � I <br /> DO NOT WRITE BELOW THIS LINE � ' <br /> PERNiIT CONDI710N5 <br /> 1, All calls lor inspection shall be made 24 hrs. in adv,nce- phone 259•881 5. � <br /> 2. A!I work shall be performed in acwrdance wilh this permit and current Ciry of Everett Design and Construction <br /> Star.dards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> `�. Gl��it,� To d'E' Z�o,vE J�',e i9�r`9c,s/.�D O <br /> S.f'ET/Y H•t/./, ST.qivp/�,¢OS �E.s")9i�S' . <br /> � <br /> � <br /> �., �_ V�O d- �wS� a`<<r•✓ OB/19/86 11:Sr.�AM OOORM1542 � <br /> �/ <br /> �.�� 5,,....�.� � �.�� � Gk� �T.Zo ;35.� a <br /> ^ II1/"1J G�EG; f35.00 <br /> v�.Y v�'o .�1.� �..r4 r T F7e(J�� !J J <br /> Q \ 1 <br /> / <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save�harm- <br /> less Ihe City of Everett from any and all claims for damages, costs, <br /> _%�-� — � ezpenses, or causes of action that may arise because ol installation <br /> and maintenance of the improvement or other right-o4way use hereto <br /> i e-rt B �9 6 applied for and furiher agrees to remove same upon notice from the <br /> A loved or nstructio �a�e City d to replace puqjic pr rq�damagedth ere <br /> / �ES�bS��rt �io2,�yd� riv��.�..� <br /> i / ��G—//- y-rF� '--o ��,// <br /> FINAL SPEC ON � Date � '�^'� �^��'L���� " �4/�� <br /> Signature of Applicant Dxle <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STP. TED N'ITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br /> � 3200 Cedar Street BE DILIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonr.: 2E9�r?815 PROJEGT OVER 90 DAYS DURATION. <br />