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�� <br /> Date /•J�� wm�owo,k.va,m�i. � — `��/'"_ � <br /> Application For eiaq oec�., _ I <br /> PUBLIC WORKS PERMIT P�°;o°Fe`°° s_ <br /> less Aoo�Fee Pna S_ <br /> Print or Type Only e•�•�=ao�� S ���� <br /> C�J��. �'c�� s��.�i- c�, ���� 9��03 as9 �9e � , <br /> Owner Mailing Address�/ City Zip Phone i <br /> �'�tt!/ �n�u�' /93�{- ,9���,{ .Uai q��,-,,,�.,, 9BZz� �Sz-9�s/ <br /> Appl�Cant MailingAddress City� Zip Phone <br /> e �! �� Pn.G�' ,�/)!� I <br /> Describe Pro osed Work [-Giu�1'� y2 /�U+�i �'�iG ��n� �� ,G.� <br /> W <br /> Project Address(if known) `•��3/ ('OLB(/ � <br /> Aftach lour(4)copies of plans lor proposed work- Draw to scale antl note the lollowing as applicable: � <br /> • Property Lines • Centerline of stree� � <br /> • Outline and dimensions ol all existing and • Intlicate North <br /> ptoposed structures on the lol • Show any proposed grading chenges <br /> • Existing and proposed u�ilities • Show measurements � <br /> �O NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shatl be pertormed in accordance with this permit and current City o1 Everett Design and Constru:tion <br /> Standards and Specilications. <br /> 3.Cell Location Underground Service 4B hrs.befure you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> `� .7�}'�,,.c� 7,r.�-�,1� .vno fa.lf' I8 N i3n/r->�.�iLe� SC�Pc�✓n[/�. � <br /> CJ/���tt- SZl�f.�t✓� �Jy -�JFP/ -li.' � S'�cr.f �c�„�j �c�2L7�inur.� � <br /> !/ U <br /> ✓� .1�.v�,z-r_e.. �Jn�.a7` �oJ ahn-v�•� �e� aJ2ti �+'�a-92�lYR/9022:S5FN OOORq0195 � <br /> �'1 C v`oc�cJ �cc�ii �, � � <br /> �,cc� �y 4'-t �/¢� �c�_7�'NWtl3£921 <br /> o�u�r.� s�o.00 a <br /> CHECF; t�0.00 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedappiicant hereby agrees to hold and save harm• <br /> less the City ol Everetl irom any and all claims lor damages, costs, <br /> � / expenses. or causes ol action that may arise because ot installation <br /> �' .4j /�y ��_�� and maintenance ol Ihe improvement or other right-ol-way use hereto <br /> f�� �� �r¢�Q applied lor and luriher agrees to remove same upon notice from ihe <br /> Approved for Construction Date City and to replace pubiic property damaged thereby. <br /> ��; <br /> �� .�-�6- >�o <br /> FINAL�INSPECTION Date <br /> Approved as Conslructed Signature ol Applicant Dale <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED OY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> Everett,WA88201 BE DiL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br /> Phone:259�BB�0 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />