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� � � � _ --- - - . . <br /> ti7 P""" PuElkWerbVermX• <br /> io c Date � �;I i �I � Z)/�3 <br /> b � � emu oem.• <br /> �. qpplication For <br /> PUBLIC WORKS PERMIT °°°'„"'°�.`°° <br /> F�I <br /> TMai Fxe S <br /> O C O ��ss A�o����va�a � - <br /> � N M ......,.ni:� S <br /> � � � Print or Type Only <br /> O M <br /> n =° � A/ <br /> /�' d Plu,ne <br /> � ~ � Owner� MaiNng Address City Z�n <br /> H <br /> H H <br /> y la ���1 <br /> M <br /> � y Applicant MailingAddress City Zip Phonc <br /> � � [r9 D �I ��,, <br /> �'a' y � � J �flii i�/�f�'-N <br /> y Descnbe Propo6ed Work I Pi+n�,� I�M 1�1T�UCBIPFl <br /> W <br /> P�oject Address(il known) 3� o f-I� rn n�I�i �/ � <br /> qttach lour 14)copies oi O�ans�or proposed work-Draw to scale and nole lhe lollowing as applicable: �� <br /> • Property Lines • Centetline ol streel � <br /> • Outline a�d drmensions of all eaisting and • Indicate Norih <br /> proposed structu�es on ihe lot • Show any proposed gradin9 changes <br /> • [risting and Uroposed ulilities • Show measurements /� <br /> w <br /> i�� DO NOT WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS � <br /> ' i.All calls br Inspection shall be made 24 hrs.in advance�phone 259-8870. <br /> 1 ' 2.All work shall be pedormed in accordance with Ihis permit and current Cily of Everett Design and Construction <br /> � �� Slandards and Specilications. <br /> � 1 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> � <br /> � <br /> '�� <br /> I ��' . . !,j � � <br /> � � r ,,� ( <br /> �i�'L!-4_� Ct'J�lz�- f._'_ �-��. t ; ..�� , <br /> !,1�1 �,% � <br /> � � .:- , � � <br /> a <br /> r � <br /> 11q' ' <br /> I I <br /> AGKNOINLEDG[MENTOF CONDIIION <br /> ����� The undersi9ned ownei/applicant hereby agicus In hold antl save harm- <br /> less the City of Everett Irom any and all claims �or damages, r,osl:,. <br /> expenses, or causes of action that may arise bucause of installation <br /> and maintenance ot ihe impiovement or olher righbof�way use h��reto <br /> applied lor and lurlher nqrees to iemove same �non nnc�e hom Ihe <br /> Approved br Conslruetion L'ate Ciry and to r�placr nubhc n�operty damaged Ihereby. <br /> FINAL INSPECTION Date — � p��� <br /> Approvetl as Construcled Signaiwe ol Apphcant <br /> WORK AUTHORIZED BY THIS P[RMIT MUST B[ STARIED W�Tf4N <br /> �� PUBLICWORNSDEPARTMENT 180 DAVS OF DATE P[RMIT IS ISSU[D AN� THEREAF7ER IS f0 <br /> � �+� 3200Cedar5lreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br /> Everel4 WA98201 CANCELLEO BV THE CITY UPON ANY STOPPA(3E OF WORY.ON fHIS <br /> Phone:259�0810 PROJECT OVER 90 DAYS DURATION. <br />