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Date���� y!,J$'—��� <br /> PUCI�t Woh's Pa�mtl� _(L <br />"�' APplicati0n for eieo.000+.� �T—� <br />� PUBLIC 4'VORKS PERMIT <br /> Publm wo:b Pee <br /> Total Fae S— �� <br /> Leen ApV�Fea PaiO S f�'� <br /> Print or Type Only Belence Dua s�.?i <br /> �'-�'J`�'..�'E�'L <br /> F//�.�E'rT ,���� <br /> Owner Mailing Address City 2ip Phone <br /> ��e.c,k �� Na �,r�ooaS4a�d� /�-l�zf �(ly 9� l�.�,��ooa l*�/S'�l ��30 2 E? � <br /> � Applicant Mailing Address Ctty—� Zip Phene � <br /> 1 � � <br /> Describe Proposed Work ^ w <br /> �}— /� �37SZ � <br /> Pro�ect Address(il known) �3l'3 � "�w � <br /> � Attach lour(4)copies of plans for proposed work-Draw to scale and note the following as applicable: � <br /> a • Property Lines • Centerline of street � <br /> I • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br />' PERMI7CONDITIONS O <br /> t. All calls for inspecticn shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be pertormetl in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �G�� f�%°"fI�"crl2� /�L�9/1�,,5' C�'-'I�7�� ����,� <br /> . O <br /> � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> ' . less the City of Everetl Irom any and all claims lor damages, costs, <br /> ��� expense:, or causes of action that may arise because ol installation <br /> and rraintenance ol the improvement or othe� right-of�way use here;o <br />� Ap o d lor Cdnstru n applied for nd further agrees to remove same upon notice from �he <br /> i/��+ Date City and place public property damage (hereby. <br /> �i Z/�— Pf <br /> FINAL I CTION Date 11 <br /> Approved as ConsVucted SignaWre of A4�PI: ' <br /> Dat <br /> everett PUBLIC WORKS DEPARTMEN? WORK AUTHGRIZED BV THIS PERMIT MUST 8E STARTED WITHIN <br /> � 3200 Cedar SVeet 180 DAYS O�' CATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLEJ BV TI1E CITV UPON ANY STOPPAGE OF VJORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />