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� � 7 � <br /> Date -� -�- 1 Pu�i¢Worte Perm�t• �� "���,G� <br /> AppiiCation For emo.oeoi.•�.23-71U&S <br /> PUBLIC WORKS PER11►i !T ��°;o;;�s�`�° s <br /> lessA00� FeaPaiC S — <br /> Print or Type Only BslanceDuo � ?p ou <br /> J3r c'�,��,���1;:�:,, �� rU sF ���,� ►�,�1�i�wc „ r?-��{ c�,�,eH' ,ss-s�x� <br /> Owner Mailing Address City Zip Phone <br /> —1'�.1.-fM1t l�. <br /> Applicanl Mailing Address City Zip Phonc <br /> new <br /> � ��- r " <br /> Describe Proposed Work _��, - �� � �' Gi i7(P✓�ti�/S� 1�� �� �A�, /1n <br /> � � _ � i ^� ��� ������ <br /> i"!nn c�'�e �5y1-� ,S-p�-#e�nr�i�T,`,�,�. i �ir�,l--LTi-"��,,,-�=f-1A�� i <br /> - s��, - W � <br /> Project Address lif knownl `�� !��'O�iDC��Y � I <br /> Attach�our(4)cOpies ol plans lor proposed work- Draw to scale and �ote the lollowing ns applicable� � <br /> • Property Lines • Centenine ol street � <br /> • Outline and dimensions ol all existing antl f Indic�te North <br /> proposed etructures or the lo� f Show any preposed yraGing changex <br /> • Eaisting and proposed ��ili�ies • Show measuremenis � <br />� DO NOT WRITE 6ELOW THIS LINE O <br />� PERMIT CONDITIQNS <br /> 1. All calls for inspectioi�:snell be made 24 hrs. In advance- phone 25J•881 ti. � <br /> 2. All w�rk shell be perlormed ir. accordance with this permit and ccnent Cily ol Everett Design and ConsVuction <br /> Standards and Specilications. <br /> 3. Call Localion Underaround Servica 48 hi; before you dig.TOIL FREi N'�,dBER 1-800•424-5555. � <br /> �-----�_,` O <br /> �' �� <br />� ��is�� . � <br />�.� � - _ � <br /> � '" ���� , o <br /> �, �U� � a <br /> ' :. _ �, \ � <br /> � - . ACKNOW�GEMENT OF CONDIiIONS <br /> �L,n/�"� _ The undersigned owner/applicant herebp ayrees to hold and save harm- <br /> less Ihe City ot Everett irom any and all claims lor damages, costs, <br /> / ezoenses, or causes ol action Ihat may arise because ol install;ilion <br /> ��'C'/��, / �� - 'g and maintenance of ihe improvement or other right�ol-way use hereto <br /> r c'-r -- <br /> �— applied for and further agrees to remove same upon notice irom Ine <br /> Approved tor Conslruction ��� �- i Date City a d to replace public properly damayed thereby. <br /> _ " .G -' �<-uc�--�- /d •/G -d-�F ��� .v�Cli�.l. J �J��xy..d/ <br /> �I�AL INSPECTION Date ��- ��� <br /> Approved as Constructed Si na re lcan Date <br /> everell PUBLIC WORKS DEPARTMENT WORK AUTHORiZED DY THIS PENMIT MUST BE STARTED 1NI1HI�d <br /> � 3200CedarStreet 180 DAY: OF DATE PERM1IIT IS ISSUED AND THEREAFTEP IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMf�LETION. THIS P[RMIT M,SV BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY;;TOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />