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Date��� � � _ ,: ,. ,.__ ., - <br /> AnPlicaticn For �..," °.-'� ` -"��/`�_L'��� <br /> PUBLIC WORKS PERMIf P°°��°W���s°�� — <br /> 10IAI«� S_ <br /> Lrss�nu�fee Px�tl S _ <br /> Print or Type Oniy ea�r�,;P o��a s _ <br /> ` n SN��e /CYi? <br /> �V2�cr1f' �1G�- �r�� �7 Rox 536G '��—`f�-5`� <br /> Owner Madmg Aadress Ci1y Zip Phona <br /> Sp�rl P <br /> ' AFPlir,anl M811ing Adtlress Cqy Zip phone <br /> DescnbeProposedWork �,Q,� � �/� J/jOhLYf7ia'� ( b /. /��- __ _ _ <br /> Pro�ect Address Id known) ��do2 l l71��V� �� � � <br /> � <br /> Atlach lour 14)copies ol plans for proposed work� Oraw to scale and note the lollowing as applicable: � <br /> • Properiy Lines • Centerline of street � <br /> • Oulhne and dimenslons ol all e.�simg and • Indicate Norih <br /> proposed sfructures on Ihe lot • Show any proposed greding changes <br /> • ceisl�ng and proposed utilities • Show measuremenfs � <br /> DO NOT WRITF BELOW THIS LINE <br /> PERMIT CO�DITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in ativance•phone 259•8870. � <br /> 2.All work shall be pertormed in accordance with this permil and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Undergrcund Service 48 hrs.6elore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> ��� ������ � <br /> c��...�a-�� ~ <br /> N <br /> O <br /> a <br /> ACKNOIYLEDG[Id[NT OF CONDITIONS <br /> Thc undrisigned owneUanplicant here6y agrees to hol.1 antl save harm� <br /> - iess ihe Cdy of Everett Irom any and all claims for tl�mages, costs. <br /> I exUenses. or causes ot action ihat may �rise becausc of inslallallon <br /> and maintenance oi Ihe improvement or other nghbol�way �sE� herelo <br /> applied for and lurther agrees to remove same i�pon not�c> Irom the <br /> AFPioved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSi'ECTION Dale <br /> Approved as Consiructed Signature oi Applicant Date <br /> evereU PUBLICWORKSDEPAr�TMENT WORN AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CeDarSlreel 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA9B207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEF�11T t,1aY BE <br /> Phone:25S�BB10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF IVORK ON 1HiS <br /> PROJECT OVER 90 DAYS DURATION. <br />