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�:�� ^ <br /> pB�B a��oec W,.�e na� /'J� <br /> ApPlica�ion Foi ema oeo� • _S�(�5��.��--- <br /> PUBLIC WORKS PERMIT PuLloWien'�� �-- — <br /> 1 ea�An�� �ne Pua S___ ' <br /> Print or Type Only o•�•�«o�. 5_ <br /> ''�%i✓I/l '-PC� �'`)Y .�?[`�7 /�/.5 l�l-l-'>J� `,�.II1F �ld�l �l��41R' <br /> �iOwner Medm{�AAd�ess C�t�y—� Zip Phone <br /> Appiieant MaiBn9 Addrecs CiIY -- LP —_ Phone ��� <br /> Descr�be Proposetl W�ork � - � ��-�� �I�`�--�� ��L]l.L�� � I <br /> �1.dL�=t�—a —.. , _ <br /> , - y-�,� W <br /> Prolect Address Iil knowN •��/ �J � <br /> A�lach lour(41 copies of plans lor proposetl work� Draw lu scale antl note Ihe lollowmg as applica6le: � <br /> • Property Lines • Centerline ol slreet � <br /> • Outlina and dimensions of all e�isting and • Indicate North <br /> proposetl structures on the lot • Show any proposed grndiny changes <br /> • Existing end proposed utilities • Show mnasurements � <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calle lor Inapectlon shall be made 24 hre.in advance•phone 259-881 O. � <br /> 2.All work ehall be pertormed in accordence with thia permit ond current Clty of Everett Deaign end Construction <br /> Stnnderda and Spectllcelions. <br /> 3.Call Locetlon Underpround Service 4B hre.belo�e you dig.TOLL FREE NUMBER 1•800-4245555. � <br /> }��Gu��i ��n�.�� ���-t����'�vr�a'" �� "9� � <br /> �� � : <br /> � � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/upplicant horeby agrees to hold anA save harm• <br /> Iess ihe Cily ol Everett Irom any and all claims lor damages. cosls. <br /> e.penses. or causes ol action �hat may anse beceuse ol inslallation <br /> and mainlenance ol the improvement or olher right•ol�wey use herelo <br /> — apphed �or and lurlher aqrees �o remove same upon notice Irom ihe <br /> Approved lor Construclion Dale ���y y����� replace public propertl'damaged Ihoreby. <br /> FINAL INSPECTION Date <br /> Approved as ConsVucted Sign�Iwo ol Applicant Dute <br /> WOiiK AUTHORIZED BV THIS PERMIT MUST BE STAi7fED WITMIN <br /> eve�ett PUBLICWORKSDEPARTMEN7 1B0 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200CedarS�ree1 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT t�AAY BE <br /> Everell.WA99201 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WOFK ON iHIS <br /> Phonx:259�8810 PROJECT OVER 90 DAVS DURATION. <br />