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�8�e�fJ�C� Pub4c Worb Permil� , yJ, <br /> / / � <br /> AppIiCB�lon For omu oeoi •. <br /> PUBLIC WORKS PERMIT P,Gio�nliee`ee s — <br /> Lee��ypl Fea P�iJ 5� <br /> Print or Type Only B�ianceDue f <br /> Tl,c Cd �D Bc,r 3��� � SP���P- �d'�a� 3�a-r� �j — <br /> Owner MeJInB Address Ciry Zip Phone <br /> Applicanl Meiling AJdress City Pp Phone <br /> Deac:Ihe Propoaed Work _ ��d�D�1)�/P P. Sa n/. (�A 1 �( /(1/ /�Q��/Q� <br /> W <br /> Frol�ct Atld�ees pf known) � � <br /> Attach lour(4)copies ol plena lor proposed work•D�avi to scale and note the lollowing as applicable: r <br /> • Properly Linea • Centerline of slreel � <br /> �Outlinc end dimensions ol all existing and • Indicate No�th <br /> proposetl structuren On the lot • Show eny proposed grading changes <br /> • EMieting end proposed utllillea • Show meesurementa � <br /> DO NOT WHITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.All celle lor Inepection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work ahall bo performed In eccordance with thla permit end current City ol Everell Design and Conatruclion <br /> Standardn and SpeciNcationa <br /> A.Call Locatlon Underpround Servlce 48 hrs.betore you dig.TOLL FREE NUMBER 1•800�424-5555. � <br /> �c�C�� �v�- ��f .r� �.� � <br /> �� �� � <br /> 7'/��99 � <br /> � <br /> a <br /> ACKNOWL[OGEMENT OF CONDITIONS <br /> The undersigned owner/epplicant hereby aBrees to hold end save harm• <br /> less Ihe City ol Everett Irom qny and all claims lor tlameges, cost& <br /> expenses. .r causes of acticn Ihat may ariae because ol installetion <br /> and maintenance ol Ihe improvement or othor right�ol�way use hereto <br /> nppl�ed lor and luriher aprees �o �emove same upon notice Irom the <br />� qpproved lor Construction Date �i�y end lo replaca pubGc property damaged �he�eby. <br /> FINAL INSPECTION Date <br /> Approved a9 Constructed Signalure ol Apphcant Onle <br /> everett �UBLICWORKSOEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> � 3200CederStrae� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet6 WA98201 BE DILIGENTLY PURSUED TO COMPLE710N. THIS PEfiM1T MAY BE <br /> Phone:259�BB10 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />