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�Ate�B� ~ �` PuUtic Worh�ParmGO2�^7 on�� <br /> Applicetlon For eioo oao��•�.,]! �(�' / <br /> PUBLIC WORKS PERMIT P°°ro,:FaeFae , <br /> Lan AOC<<ae PtlC S_ <br /> 9.i.nc.ou. • <br /> Print or Type Only <br /> ��r'� R7 �{ �7n'7 M/S nl-I-2� �'nz�. 9g,1�� �2-r�8�1 <br /> Owne� " Meilinp Address Clly Zlp Phone <br /> � /� <br /> Applicant Malllnp Addresa City Zip Phone <br /> Describe Proposed Work ��� ^�(�tP�� I <br /> i <br /> �, c�. cs�s���n �r �,^ W � <br /> Pro�ect Addreee pf known) � �'� � <br /> Attach lour(4)coDles al plens lor proposed work• D�aw to acale and note Ihe lollowinp ae appllceble: � <br /> e P�opeAy Lines • Centerllne ol slreet � <br /> • Outline and dimenelone of ell exls'Ing and • Indicate NoAh � � <br /> p�oposed etructuree on Ihe lot � Show any propoaed gradlnp chenpee <br /> • Exlstinp and propoaed utllltlea • Show meaeuremente � I <br /> I EL HI L N O <br /> PERMIT CONDITIONS <br /> t. All calls lor Inepection ehell be mede 24 hrs. In edvence• phone 4b�•8B1 5. � <br /> 2. All work shsll be perlormed In accordence with this permit end current City ol Everett Design and Conelructlon <br /> Standarde and Speclllcetlone. <br /> 3. Call Locatlon Underpround Service 48 hra. belore you dlg.TOLI FREE NUMBER 1•800�424•db35. � <br /> O ! <br /> PLJb�L/C L�•�t'S i�E•em.7 �OT i<'Eq(/iieEO .�?2��� � , <br /> c�C�!% <br /> � ! <br /> OI <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hotd and save harm� <br /> lesa Iha City ol Everett irom eny end all claime lor damapea, costs. <br /> expanses, or ceuaes ol ection ihal may arise because ol Inslaltation <br /> anJ maintenenca of the improvement or other rlght•ol•wey uae hereto <br /> applled for end furthar agrees lo remove same upon notice Irom Ihe <br /> Approved lor Construction Oate City and to replace public proptrrty demeged theraby. <br /> FINAL INSPECTION Date �� <br /> qpprovad es Constructad Signature of ApD��cant Dete � <br /> everett PUBLIC WORKS DEFARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAFiTED WITHIN { <br /> � 3200 Ceder Street 180 DAYS OF DATE PERMIT IS ISSUED AND TF{EREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE '��. <br /> Phone: 259•BB75 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS � <br /> PFOJECT OVER 90 DAYS DURATION. <br />