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� <br /> Date�4 � ^� <br /> . v„ni��wo,.sv.,m�i. --------' <br /> mnu oe�� . — <br /> Applica�ion For - <br /> PUBLIC WORKS PERMIT c°^°=W°,���°°--- - <br /> �„�,�«, s- <br /> ��,,.�„� �..Pw„� s— <br /> �.,�.,,, ���� s <br /> Print or Type Only <br /> _�P ���1l1O �a �r��x3�c� r��s o�-z� �1e 9��— <br /> "p�y�e� / . Madmg Address Ctly Zip Phone <br /> /ylel l��P�c.�. 3�{a - 79Y�y_ <br /> Applicant Mailin¢Address Ci1y Zip Phone <br /> Describe Propoaed Work LY I��N.1l UN /`r '7CJ J� �3�� /NLL _ <br /> .-T.�. <br /> Pfolett Atldreee lil knownl �(`�� �Lt� �T �N b /�A/ � <br /> � <br /> Altach lour�4)copia8 of plans lOr propOsed work� D�aN lo,ca�e antl note Ihe loilowing as applicable: � <br /> • Property Linea • CenteNine ol sireet � <br /> • Outline end dimensions al all eaistina antl • Indicate North <br /> proposetl siruCtures on the lot • Show any proposed grading changes <br /> • ExistinA end proposed utillties • Show measuremenls � <br /> DO NOT WH�TE BELOW THI LINE O <br /> PERMIT CONDITIONS <br /> 1.All calla for Innpectlon ahell be made 24 hr6.in advence•phone 259•881 O. � <br /> 2.All work ehall be peAormed in eccordance with this permit end current City ol Everett Design and Constructlon <br /> Stendards and Specilications. <br /> 3.Cell Locetlon Underground Service 4B hrs.6elore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> O <br /> �Lc �cl! � lc.,Jt,a�L ,Jc' : �n � l .✓t-��.r /�-i 4� 't + t r�^ � <br /> b � <br /> '"- J'ilr-ij`� <br /> �:.� �����,�. ' O <br /> a <br /> ' ACKNOWLEDGEM[NT OF CON�ITIONS <br /> ihe undersigned owneqapplicanl hereby agrees to hold and save horm� <br /> — less the Clly ol Everelt iwm any and all claims �or tlamages, cosls, <br /> e�penses. or causes oi action that may arise because of inslellalion <br /> � and mainlenance ol the improvemenl or olher righhoFway use hereto <br /> appGed lor and Iwlher aQrees to remove s�me upon notice IrOm ihe <br /> Approved lor Conslruc�ion Date City and ro replace pubhc p�ope�ty demaBad Ihereby. <br /> FINAL INSPECTION Dale <br /> Approved ns Constructed Signatwe ol Appl�caN �a�e <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAVS OF DATE PERMIT IS ISSUED AND THEAEAFTER IS TO <br /> � 3200CedarSlreet BE DILiGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 OAVS DURATION. <br />