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Pul.lic Worxe Pe�m�l� ----�C��` <br /> Dete��7 / <br /> / F1NA OaPt • <br /> � Appllcation For <br /> PUE�LIC WORKS PERMIT ) P����cWod�ixe s z= <br /> �/J tal��Fes <br /> /���'^nn('�"T 'IYi.137�� Le���uol FeeP��E 6 f� <br /> /�•�'�rl/ �� ' Bebnce0ue s <br /> Prin? or Type Only � <br /> �c� - <br /> �� Owner Meiling Address , <br /> CItY Zip Phone <br /> i � ( /rir�� ';oos' frbvT ��r�ri/ �.YLo/ 339/S-Ls- <br /> ���Y Z�N Phone <br /> �{ y A"e np����� Maillnp Atldress <br /> � � r � n� ,�'<' Ats- 'T7t«s Ar� � t�nn i.� �e�_c � <br /> Deecribe Proposed Work � �rd� <br /> CX��T_ A F.eu i4c.o�,es f� ?/✓ F,Aoni oF Tii� n.�co�2-f'„ — <br /> __ � '�Q� W <br /> prol��Addreee(�1 know�) <br /> ///5� � C.9s..va .eo — �" <br /> � <br /> Attech lour(4)coples of plene lor propoaed work•Drew lo acale end note iho lollowing ea epplicable: � <br /> • Properly Linee • Centerline ol elreet <br /> •Outllne and dimenslona ol�II exleting end • Indicate North <br /> proposed elructurea on Ihe lol • Show eny proposed gradlnp chenges � <br /> •Exietinp end propoaed utilitlea • Show meesurements <br /> DO NOT WRITE BELOW THIS LI��E � <br /> PERMIT CONDITIORS � <br /> t. All calle lor Inepe�:tlon ehall be mede 24 hra In advance-Dhone 259•881 b. <br /> 2. All work ahall be peAormed In accordence with thle permlt end current City of Everett Deelgn nnd Conetrucllon <br /> Standards and Speclllcatlona � <br /> 3. Call Locellon Undergtound Servlce 4B hra.before you dlg.TOLL FREE NUMBER 1•800•424•5555. <br /> ,�l /-'�us/on /'cy�►l'��`1-�✓ �� � .�!'1 s�-�'-�-/�" O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEGfiFMENT OF CONDITIONS <br /> The undersigned o++r.�r/epplicant hereby aB�ees lo hold end save harm- <br /> — less the Clty of Evere�l fram eny end all cleims lor demage& cosls, <br /> : - - . �; expenses, or ceuses ol ectlon Ihat may erise because uc Inetellallon <br /> -�— -- . ,-�� /// /�,i� and nalntenance of the Improvemenl or other dghbo4wey use herelo <br /> ��_1"� ep011ed lor and lurther agrees to remove seme upon notice irom the <br /> Ap �ved for Conalractlon Dele �Il lo reptace public property demagad th reby. <br /> . � <br /> � <br /> 1 <br /> FINAL INSPEC7IQN Date Dete <br /> Approved ee Conelructed Bign re of App Ice�� <br /> K AUTHORI2ED BY THIS PERMIT MUST BE STARTED WIT111N <br /> everett PUBIIC WORKS DEPARTMENi 0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett,WA 88201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORH ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAVS DURATION. <br />