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ur' _- _ _- <br /> Date�, �x� <br /> ��5 Pu�bc WOMPerm�t• <br /> Applitation Fo� eiap oeo+�• <br /> PU LIC WORKS PERMIT PU�TotelFee`eB S_�-5z�'� <br /> �oss nno� rre�x�� � -- <br /> Print or Type Onl� � � � � �(� �M s g gpM � � �����r ��u�• s <br /> N `Om .Mr111M .�i � M P � <br /> .-� M M M � M N � � 4'1 <br /> rnc " , " - " � u -_;� � s-�;%;cc. ��v����l s�a�-9�� <br /> Owner ^� r� � "'�ilk1 � � � � ' Cit Zi� Phone <br /> J � <br /> N�- r ~ � � Z W -_����-1 Pc �ao� T�11G�/(,(Q °r�b0� <br /> Applicant Ma�liny Addicss Cdy Zip Phone ��^-� ^ I/'� <br /> r fT7' LJ�J <br /> Describe Proposed Work ������ �S ���l�sa—��"l <br /> /l W <br /> Project Address lil known) 70z0 —" COLC7'r/ A✓.E � <br /> Attach four(4)cop�es ol Rlans lor proposed work� Draw lo scale and note Ihe followinq as applica6ie�. � <br /> • Prope�ty Lines • Centerline of street � <br /> • Uutlmr, and dimensions ol all existmg and • Indicate North <br /> proposed structures on ihe lol • Show any proPosed gratl�ng rhanges <br /> • Ezisting anA proposed u6lities • Show measu�ements � <br /> DO NOT WRITE BELOW TI115 LINE O <br /> PERMIT COIJDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.in advanCe-phone 259•8810. � <br /> 2.All work shall be pelormed in acco�dance with this permit and current City ol Everett Design and Construction <br /> Standards and Specllications. <br /> 3.Call Localion Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> -�. i�er ai�ra.v�'c�/�.�s d.r.�e� (�-Z 9 -f�B O <br /> if' / <br /> s. ,� c��-��- �'/� , �� (� ,. � S r� v,;�� ��� �f 1 <br /> /� ��-�e �'-�����-��� �«��.N�/ � I �' <br /> ( U�b�7/ • <br /> /S.l'l�-��, � <br /> 0 <br /> a <br /> ACKWG�ti'L�UG[MEIJT OF CONDIj10N5 ', <br /> Thr undersignetl owner,�applicant iiereby agrees to hold and save h��m� � <br /> less Ihe City ol Everet� Irom any and all claims for :amages, costs. <br /> expenses, or causes ot action that may arise because of installation �, <br /> ` v and maintenance ol the improvement or other nght-o�-way use hereto <br /> � �"– � � applicd 'o nd turther agrees �o remove same upon notice from the <br /> oved� Cons cti � , Date City and:to repi ublic property dama9etl thereby. <br /> �� 9-��� �--� ► a ��� <br /> F�NAL INSPECTION Date <br /> Approved as Construcled Siqnature of ApplicaN Date <br /> evereu PUBUCWORKSDEPARTMENT WORK AUIHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br /> 780 DAYS OF DATE PERMIT IS ISSl1ED AtJD THEREAFTE(7 IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO GOMPLE7lON. THIS PERMIT �AAY BE <br /> Eveiett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THiS <br /> Phone.259�8810 PROJ[CT OVER 90 DAVS DUFATIOIJ. <br />