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Date� P�m�o wo�.s v�,m,�. —�l1 El j� I� <br /> Application For emq oeM • <br /> PUBL.IC WORKS PERMIT '°�°°W°^"°° - ', <br /> Tobl Fee s <br /> leu�DOI iee P��d S I <br /> 6elanceDee 4 � <br /> Pri,�t or Type Only <br /> .�].�5.1.�--�ALI 3�d� rn�L�! G VAiP I� �iJ/9' Q�ZW � S�- 3SS_� �I <br /> Owner ✓J Mailmg Address Cdy Zip Phone <br /> ma9�o�i��3�9r9- <br /> m�- � ��nn� n-�-�. .�--��l—�Q (�nr IS4/) /1�f(�n�.r�i, !/a j�FZz('j (aS4-z/2�/ � <br /> qpplicard � Meaio9paare55 C�t��-�_ ZiP Phone ., <br /> _�� �i�h�=�1TP�—� — !I I <br /> Describe Proposed Work '��nP� 1 � � 1 X IS Ab !/S--P <br /> _ _ W ' <br /> Projed Addres5lil known) � `� ��� <br /> � i <br /> Attach low(4)copir.s ol plans lor proposed work• Draw to scale and no,a the follo�ving as applicable: � .i <br /> • Property Lines • Centerline ot slreet � <br /> • Outline and dimensions ot all exisling and • Indicate North � I <br /> proposed sVuctures on ihe lot • Show any proposed grading changes <br /> • Fxlsling and proposed u�ilitir.s • Show measurements M � <br /> �� DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS O �i <br /> 1.All calls for inspection shall be made 24 nrs.in advance-phone 259•8870. � �, <br /> 2.All work shall be pertormed in eccordance with this pe�mit and current Ciry of Everet�Design and Construr,tlon <br /> Standards and Specifications. <br /> 3.Catl Location Underground Service 48 hrs.belure you dig.TOLL FREE NUMBER 9-800•424•5555. � I <br /> � <br /> ��� �G^�- �`�f/`�B <br /> O 4 <br /> v �� I <br /> � <br /> O <br /> a <br /> ACKIJOV✓LGUGEI.IEN1�OF CON�ITIONS <br /> 7he undaicgnrd ownen appllwnt hereby agrees to hoid and save harm- <br /> — les; the Cey ol Everett from any and all claims lor damages, cosis. <br /> expenses. c c�uses ol aclion Ihat may arise because ol installation <br /> and rt'.ainl?nance ol ihe improvement or other nghbof-way use hereto <br /> - applied for and lurther agrecs to remove same upon notite Irom Ihe <br /> Approv?d lo�Construction Date City and to replace pubhc oroperty damaged thereby. <br /> FINAL INSPECTION Date <br /> Approv2d as Constructed Signature oi ApD�icant Uate <br /> WORK AUTIIORIZEO BY THIS PERMIT MUST BE STAFTED WITHIN � <br /> everell PUCLICWORKSDEPARTMENT t80 DAYS OF DATE PERMIT IS ISSUED AN� THEREAFTER IS TO <br /> � 3200Cedar5lreet BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett,WA98201 GANCELLEJ BV THE GTY UPON ANY STOPPAGE OF WORK ON TNIS <br /> Phone:253-8810 PROJECT OVER 90 DAVS DURATION. <br />