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/ <br /> Date 3-l3-�I Pum�c Wor��Permn• 91 ��S _ <br /> � Applicalion For e�no oeai • <br /> , PUBLIC WORKS PERMIT PuoTo�n���Fee a <br /> Leff�p0� �ee VI�U S <br /> Be�ence Due S_�� ^ <br /> Print or Type Only <br /> k-�e (ev� W� 2;dev `.�909 CadH fZ� C—�p,.�E{� �1(a �Z� 353- 934C� <br /> Qwner Mail�ng Adtlress Cily Zlp Phone <br /> Applicent Mading AdAress City Zip Phone <br /> Deac�l�e Proposed Work ���Z� ��5��h� 't'� bv �kh �L w�� �`pGt, reE.flivl�Hq <br /> �va(( �45ft L.o.�v b4��{E In;�1� _ <br /> - W <br /> Project Address lif known) �3�� Ggc�� rd . � <br /> Aftech lour(4)copies of plans lor proposed work� Drew to ecale end nole Ihe following as applicahle: � <br /> • Prope�ty Llnes • Centerline ol street � <br />, • Outlina and dimenslons oi nll�.isting and • Indicate North <br />� propoaetl struclures on the lol • Show eny proposcd grading changes <br /> • Existing and proposad ulilities • Show measuremonts � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIOtJS <br /> 1.All calls lor Inepec:lon ahall be mede 2�1 hrs.in advence•phone 259•8870. � <br /> 2.All work ehall be pedorme�f in accordrmce with this permit end cwrent Clly ol Everett Deaign and Conatmctlon <br /> 3tendarda end Speclficatlons. <br /> 3.Cell Locetion Underpround Service 48 hre.befo�a you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> q, Stiall be c�otis��-�cte� as �e.- c;t� oF' e..�ere.tt O <br /> s�.a�dard P Ia.� 1�3 z.�. <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiqned owner/applicant hereby egrees to hold and save herm- <br /> - - -- less the Clly ol Everett Irom nny and nll claims lor demages, cosls. <br /> e�penses. or causes of action that may erise because of installation <br /> Q 1 ��A� 3 — �S pJ` and maintennncf of the Improvement or other right�ol�way use herelo <br /> � av � rvi epplied lor and c.r�her agrees te remove same upon notice Irom the <br /> ApUroved for Construc � � � Dale Cily and to replace public property damaged thereby. <br /> "�i�ii��� r /V �� <br /> FINAL INSPECTION Date ��� - V . �,�� <br /> Approved ea Conslruc�ed Siynature ol Applicant Date <br /> everetl PUBLICY/ORKSDEPARTMENT WORH AUTHGRIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederSireel 180 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTER IS TO <br /> Cverett,WA 98201 BE DILIGENTLY PURSUED T(�COMPLETION. THIS PERMIT MAY BE <br /> Plmne:259�BP10 GANC[LLED 3V THF CITV UPON PNV S.`OPPAGE OF WORK OM THIS <br /> PfiOJ[CT OVER PO UAYS DURATI�N <br />