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�jQ�(�� -,. <br /> �B�Q�L1,(,z Q O Punl¢Wod�Per • <br /> AppIIGeHOn For a��ro oepi.• <br /> PUBLiC WORKS PERMIT PubIKWOfM�fu <br /> To1�l Fs� s <br /> Leu�polFaePuO s <br /> Print or Type Oniy B�i�nc�0us s <br /> ' 3 u 9, �A�n� 1�_�'�,�Y�' 9Fsa03_�/��'7/ <br /> wner Mellfnp Atldress Cily Zip phone <br /> Appllcant Meilinp Addreas City Zip Phone <br /> Dsecrlbe Propoeed Work �(��y���� ��'� I L71L� - _ <br /> r <br /> Pro�ect Adtlrese pl known) _1�Lrl dJ {f� � ` ( J`�y��. � � <br /> � <br /> Athch f0ur(4)co0�es ot plane lor propoaed work•Draw to scale and ncle the lollowing as applicable: � <br /> • Property Linee • Cenlerline ol atreet � <br /> • Outline and dlmansionn uf ell exisllnp and • Indicate North <br /> proponed etructuree on the lot • Show any proposed grading changes <br /> • Existlnq and proposed utllities � Show meaeurements � <br /> N HI L NIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All plb lor Inepectlon shall be made 24 hre.In advanca•phone 259�8810. � <br /> 2.Atl work ahall be pertormed In eccordance with thla pe�mit and current City ol Everett Design and Conatructlon <br /> Stenderds end 3peclllcntlona. <br /> � 3.Cell Location Underoround Servlce 48 hre.before you dlg.TOLL FREE NUMBER 1•800�424665b. � <br /> �tor ��gu<� .�/.9�8 O <br /> a�� � <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tha undersignetl owner/applicant he�eby aB�ees to hold and save harm• <br /> less the City ol Eve�elt Irom eny end all claims lor tlemaBes, costs, <br /> expenses, or causes o� action thal may arise because of Insfallatlon <br /> and mainlenance ol Ihe improvemen! or olher righbol�way use hera�o <br /> A raved lor Conatructlon Date applied for and lurther agrees to remove same upon notice irom the <br /> PP Ci�y and lo replace pubiic property damaBed Ihereby. <br /> FINAL INSPECTION Dale <br /> Approved es Conatructed S�B��atwe ol Applicant Dele <br /> everett PUBLICWORKSDEPARTAIENT WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CaderSlreet 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTEH IS TO <br /> Everett,WA9B201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:258�8310 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS �UFATION. <br />