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�BYQ�� .. . � v�o�ic wo.w vermu•�-- <br /> AppliCatiOn FOr Bie9�Dem.• �� �...3 7/ D..S <br /> PUBLIC WORKS PERMIT PubIKWOA�Fee <br /> Tol.l Fne f <br /> Le�s A00�Fee Peia a <br /> Print or Type Only 6ei�nce Oue t <br /> �� 1�l �,C�.ER �/3 9- 3�''",4�� ���T�-C 9'R;Z.� 32f 30� Z <br /> Owner Maillnp Address Ctly Lp Phone o <br /> 1 <br /> Til� pi�oCAllil' QROUP J�vL' /� /� 3 m <br /> Applicam M3uing Address City Zip Phone <br /> .-� .. <br /> -i � <br /> Deacribe Proposed Work . U/1 D/d/� k�N o v.� r��/U ,.., � <br /> N 2 <br /> v <br /> m <br /> co <br /> m� <br /> �/ W � m <br /> Prolect Address(il known) �Q�.� G�D ,L3�/ �r . _ � <br /> m <br /> Attach lour(4)copies of plans for proposed work• Draw to ssale and nole the lo!!owing as applicable: � c Z <br /> • Property Lines • Centerline of slreet � � _ <br /> • Outline end dimensions ol atl ezisting and • Indicate North � N <br /> proposed structures on the lot • Show any proposed gratling changes "� � <br /> • Ezistinp and proposed utililies • Show measurements � o p <br /> � n <br /> DO NOT WRITE BELOW THIS IINE '� m <br /> x <br /> PERMITCONDITIONS O min <br /> i 1. All calls lor inspectiqn shall be made 24 hrs. in advance• phone Z59-B$I 5. � o m <br /> 2. All work ahall be peAormed in accordance wiui Ihis permit and current Cily of Everett Design end Construction 3 N <br /> Standa�ds and Specilications. m <br /> 3. Call Locatlon Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. _ � <br /> Z �r <br /> . m <br /> n <br /> z <br /> ��5 O = <br />� � � a <br /> � <br /> -a <br /> P `� �c �`�✓''1� � !` (j � <br />� � f�� <br /> � � � <br /> P o <br /> � �.� -s� G �,l�N� Q � <br /> r � m <br />� � � � <br />� <br />� ACKNOWLEDGEMENT Or CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> tess the Ciry ol Everett from any and all claims for damages, cosis. <br /> expense5, or causes of action Ihat may arise because oi installation <br /> and maiMenance of Ihe improvement or other righbol-way use here�o <br /> applied tor and further agrees �o temovo same upon notice Irom ihe <br /> Approved lor Constructlon Dato City and to replace public property damayeC thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMEN7 WORK AUTHORI2ED BY THIS PERMIT MUST BE START[D WITHIN <br /> � 3200Cedar5lreet �8^ ����� CF DATE PERtdIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,W! 98201 �L= DILIGENTLV PUNSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phono:259�8815 CANCELLED BY 7HE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 50 tlAYS DURATION. <br />