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�. i <br /> Date�1�_L9 � � P�e�,�wa.�.Ps,m,��.,., / __ � <br /> n� kPplication Por e�nq oea� • �d�L_3 Z <br /> / -u—_ <br /> PUBU� WORKS PERMIT ���°�W�,�.�� -- <br /> ,o���.�� s-- — <br /> lRSAnoI i.r priU S_ _ <br /> � Print or Type Only °e���``Ope s <br /> �I <br /> ����n 1��ti k,�{c l�P y Z93 a l'd�L y A✓� �i�za I <br />��` Owner Ma��,ngAtldre55 �Cqy Zip phone <br /> /�a c�- Svu �Ph7 d �Un�'Cs ( ZG 5�--,Z��•S��le 9��a8 G zz - S Zi 9 _ <br /> q hcant Maihng Address Gt Lp Phone <br /> Describe Proposed Work _.�-�17/1�� <br /> W <br /> Pro�ect Address IA knownl �s3a CD/�7n � <br /> Attach four 14� copies ot pla�s lo�pro��osed work- Drav�to scale and note Ihe touowmg as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of n�l existing antl • Indicate Norlh <br /> proPosed siructures on the lol • Show any p�^posed grzding changes <br /> • E*ist�ng and propo5ed utdities • Show measuremems � <br /> DO NOT WfiITE BELOW TNIS LINE <br /> PERMIT CONOITIONS O <br /> 1.All calls ler inspection shall be made 24 hrs.in advance-phone 259•8$10. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Conslruction <br /> 513ndards and Specificatlons. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER�-800-424-5555. � <br /> i <br /> (./�Q . / O <br /> I[��z��^—��11^v�ot� � '��� �i_�-C-�`r.L.,ael <br /> -� ��!-/l�rc%- <br /> //-l- :4f <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWIEDG[MENT GP CONDITIONS <br /> The undersigned owner/apPlicant hereby agrees to hold and save harm- <br /> -- less the City ol Everetl Irom any and all claims for damages, cosis, <br /> eapenses, or causes ol action that may anse because ol inst:�llation <br /> and maintenance of �he improvement or other nghhof�way use nereto <br /> applied for and furlher agrees to remove 5ame upon notice Oom the <br /> P.pOroved for Consirudlon Date City and to replace pubhc property damaged thereby. <br /> FINAL INSPECTION Dale � <br /> Approved as Conslructed Signatme of Applicant Date <br /> evarelt PUOLIC WOFKS OEPAPTMENT W�Rh AUTHOR2ED BY THI� PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 1tf0 DAYS OF DAT[ PERMIT IS ISSUED APID THEflEAFTEN IS 70 <br /> Eve�etl.WA98201 9E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT 1.1AY 88 <br /> Phone�259�9810 CANCELLED�Y THE CITY UPON ANV STOPPAGE OF WORK GN THIS <br /> ' PROJCCT OVER 90 DAVS DURATION. <br /> I !II <br /> I <br />