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�gte�^ ��-�x / ( { puDlicWorksPermitr C <br /> V T'' O <br /> Appi(cation For eieo.o,o�x_ <br /> PUBLIC WORKS PERMIT PuoTOWFeeFea s <br /> Le95 ApPL Fa�PaIE S — <br /> Belance Oue S <br /> Print or Type Only - <br /> (�,��1rfI._ rv� L f11 ,�11 e � /(nl � Fldi,�p .1�� €�i��eff- �ZO� 35S-S/0� <br /> Owner Mailing Address City Zip Phone <br /> —C.o-�[�n� Cdns�4,rc���. //J L�n/N Sf- 5rdlv.ti,slti �i�a90 S��-�s',�/ <br /> npplicant Mailing Address City Zip Phone <br /> f <br /> DseCrlbeProposedWork [� ar, �p�� Pv�r�.��� <br /> LlprhTP /���! � !4 — <br /> 7 <br /> W <br /> Project Addreas(if known) � <br /> � Attach four(4)coples oi plans for proposed wo�k• Drew to scale and note the following as applicable: � <br /> • P�operty Lfnea • Centedine of street � <br /> • Outline and dlmensions of all existing and • InAicate North <br /> proposed structures on ihe lot • Show any proposed grading cha� ges <br /> � • ExletinQ and proposed utilities • Show measurements M <br /> W <br /> � � DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> t. All calls tor Inapection shall be made 24 hra in advance-phone 259•8815. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standerda end SAeciflcetionx <br /> , 3. Cell Locetion Underground Service 40 hrs. betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> D r � 7 ��/ O <br /> / U�l/C GeIO.C.�_..s' f�'.n/�iT /Gbi' �EqUi.E'F'.!7 _ // ,.f <br /> C���,i�l/ <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CQNDITIONS <br /> i <br /> The undersigned ownedapplicant hereby agrees to hold and savn harm• <br /> � less the City oi Everett from eny end all cleima for damegea coeta, -, <br /> expenses, or causes of action thet may erise because of inatallatlon '� <br /> and meintenence of the improvement or other right•of•way uae hereto <br /> applied for end turther agreeo to remove same upon notice frcm the <br /> .i-. Appravad ta Constructlon Date Clty and to replace public property dema�ed thareby. <br /> I <br /> i'� <br /> j FINAL INSPECTION Dete <br /> . Approvsd�a Conetructed Signature of Applicant Date <br /> i. <br /> �K PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> �� 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> ��j � Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �-i P1ona:259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> i <br />