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Date� � � r„n���wo�waPe�m� / �s <br /> B�Ja Oepl • ����— <br /> Appllcntlon ror <br /> PUBLIC WORKS PERMIT °�°:o,:FoeFee s _ <br /> leee R001 iee P�id � -- <br /> Beiance Doe 5 - <br /> Print or Type Only <br /> � � � T'�oe,r-7`"me�,7's �33�� 1�wy �r9s ��c�e7fyY��Y 75�3- 3330 <br /> Owner Mading Atldress ry Zip Phone <br /> (-}c,�ett- (,t)erT" �l�� 135� S� E�e2e7f' �i��20� 33 � - c5 �'90 <br /> Applicant Mriling Add�ess City Zip Phonc <br /> Describe Proposed Work •��V e+ G�i��a R ( I�S COn� � ��A.� a l� S��R-� iO�l4� <br /> Projecl Add�ess(il known) � 7 � a +�• 4'���� � � <br /> � <br /> Attach four(4�copies al Plans for proposed work• Drew ta scnle and note ihe lollowing es applicable: � <br /> • Property Lines • Centedine ol street � <br /> • Oulline and dimensions of ell existing end • Indicete North <br /> proposed slructures on�he lot • Show eny proposed g�ading chenges <br /> • Existing end proposed utllities • Show meacurementa M <br /> W <br /> DO NOT WFiITE BELOW THIS LINE O <br /> F'ERMIT CONDITIONS <br /> 1. All calls lor inspection shell be maAe 24 hrs. �n ndvence� phone 259•88�$. � <br /> 2. All work shell 6e pe�formed in eccordence wilh ihis po�mit end current City of Ever-tl Design and Cons�ruction <br /> Standnrds and Specificetions. <br /> 3. Cell Locetion Underground Service 48 h�s. belore you -1iq.TOLL FREE NUMBER 1•800-424•5555. � <br /> a�kT 0 <br /> P wb Iµ � .�' ~ <br /> P/'�� � � <br /> � � � �i�r 3 O <br /> /� s ,�/� a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tho undersigned owne�/epplicent heraby agrees to hold end save herm- <br /> less Ihe Cily of Everett Irom eny and all clalms lor demeges, cosls, <br /> expenses, or ceuses ol acllon thal mey erlse beceuse of inste'lation <br /> end meinlenence ol Ihe improvemenl or other right�of�wey usa yereto <br /> npn��ed lor end further egrees to remove same upon notice from Ihe <br /> nnP'uved for Conelructlon Date Cily nnd lo rr,place public properry demaged ihereby. <br /> f INAL INSPECTION DB�e — Date <br /> App�oved es Constructed Signatwe ol Appllcant <br /> WORK PUTNORIZED BY THIS PERMIT MUST BE STAR"iED WITHIN <br /> everelt PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS IS�UED AND THEREAFTER IS i0 <br /> � 3200 Cedar Sireat BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELL[D BY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJ[CT OVER 90 DAVS DURATION <br /> 'I <br />