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DetB�� � �. _ f <br /> � � n,,m��wo,xe r�„mn. — <br /> ApplitetlOn FO� fl�d0 DePI �_..y_�,J.��?��� <br /> P�IBLIC WORKS PERMIT Pub�fol�Fae��a :-----_ <br /> Lnu�DDl feeP�ie f_ <br /> Belenca�un s <br /> Print or Type Only <br /> ._._/2�-R�a.�%�t u� -- <br /> Owncr MeilingAdd�ess City Zio Phona <br /> ,.,f.��..�l-�� r �� ��r �3/ l�netcl�����.,�c�e I���iO �ya-�;2�s� <br /> Apphcant Mailinq AAdress �"!y Zip Phone <br /> Deecribe F'ropoead Work r'p���'�'� ��i(�� ��-�7- -���J <br /> — � �-•--- — <br /> — � — -- — ----- � <br /> Prolect Addrene pl known) ��-'r� � �.! /�1/�/d L-- � <br /> Attach lour(4)coples ol plenn tor proposed work- Draw to ecale end note tha IOIIowInA es epplicable�. � <br /> • Property Linbs • Centerfine ol st�eet � <br /> • Outline nnJ dimenslona ol ell existlnB and • Indira�t North <br /> prop0aed strucfuree en Iha lol • Show e�y propos^d gradi��g changes <br /> • Exls�inp eod propoaeC utllitlea • Show meesuremonts � <br /> DO NOT WRITE BELOW THIS LINE O <br /> Pf RMIT CONDITIONS <br /> 1. All calls lor Inepection ehell be made 24 hra. In edvance� phone 259•8815. � � <br /> 2. All work ehall be perlormed In eccordence with thls permit end current City ol Everett[:esign enA Co��struclion <br /> Standerda entl Specllicalions. <br /> 3. Call Location Underground Service 48 hrs. balore you dig. TOLL FREE NUMBER 1•800•42d•5555. � <br /> O <br /> � <br /> �� ��� �c�iP/7'�'i �'r C� !i/�f�� G � � � <br /> ��� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiqned owner/epplicant herehy egrees lo hold end save harm- <br /> — less the City ol Everatt iram eny end all claims for domagas, coste, <br /> eKpenses, or causes ol action that may arise becausn ol inslallalion <br /> anA mninlenxnce of Ihe improvement or ether r�glit�of�way use herato <br /> --- appGed for and further agrees to remova same upon notice Irom the <br /> Approved for Constructinn Date Cily and to replace public property dameged thereby. <br /> FINAL INSPECTION Dete - <br /> qpproved as Consiructed Signature of Applicanl Date <br /> evrrett P�BLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cadar S�reet 180 DAYS OF DATE PERMIT IS ISSUED AND THERF.AFTER IS TO <br /> Everet�.WA 98201 BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAV BC- <br /> Phone: 259�8815 CANCELL[D BV THE GTV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJ[l;T OVFH 90 DAVS DURATION. <br />