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A:� <br /> k <br /> Date1111��� ,�� �� ��,///��C///''' <br /> � Pu�6c Waxe Parmn� <br /> �149 De01 • /I I�� <br /> Applica�ion For � i <br /> PUBLIC WORKS P'ERMIT PueTONFce`ne 5 -- <br /> Less Pno� Fee Va�� $ I <br /> �r� Prinl or Type Only 8.,�.,�«o�� s • <br /> � I <br /> aH <br /> C�H ' <br /> ay�n ,�J!/�.�.e �n ^• ;t-� y�a-Y GowcF�.� 9�10 3 cS9- 5—ao/ <br /> Hxy� Owner Mailing Address City Zip Phone <br /> yxH <br /> O x O /he i c .i v /JSC,G ��� �!✓ .GCor✓i,JG .�K dR. S.voi1. �f'2 Sa .Sl� /Y7 J— � <br /> �q �-.i� Applicanl Mailin�Address City Zip Phone <br /> fA H <br /> y r . <br /> � p� Describe Proposed Work �.1�`��! � A o 4•.✓ Td SF.e . <br /> HG <br /> OH�y <br /> H^ [��7 O <br /> M,y � <br /> Project Atldress(il known) `� 8�� �� ��W�� 2 � <br /> Ca" H H � <br /> N <br /> H Attach lour(4)copies of Plans for proposed work� Drew to scale and note the lollowing as applicable�. � <br /> nq d❑� • Froperty Lines � • Centedine ol sireel ♦^ <br /> 3 [s1� • Outline and dimensions ol all eaistin9 and • Indlcate Norih V� <br /> � proposed slructures on the lu' • Show any proposed gradin9 chanyes <br /> yp y • Exisling and proposed ulililies • Show measurements � <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance•phone 259•887 0. � <br /> � 2.All work shall be pedormed in accordance wilh�his permit and current City of Everett Desi9n and Construction <br /> Standards and Specilica�ions. <br /> I� �' 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER�-800•424-5555. � <br /> � ��-1 c_ �-�-01z�� � lT- I`�� �c� <br /> I•� '� OL <br /> ' o��_V� C �— r/� <br /> I` "j V� <br /> �._. S �— �fl 0 <br /> ��-� a <br /> - <br /> !'! ACKNOWLEDGEAfENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less ihe Cily ol Everett trom any and all claims tor tlamages. costs. <br /> expenses, or causes o� action that may anse because ol insiallalion <br /> ""� and maintenance ol lhe improvement or other nghPol�way use herelo <br /> applied lor antl luriher agrees to remove same upon ootice Irom ihe <br /> Approved lor Construction Date Cily and to replace publlc property damagetl thereby. <br /> ���. <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Signature ol Applicant Oate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHiN <br /> evcrrlt PUBLICWORKSDEPAPTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32o0CedarStreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT Atav B[ <br /> Everet4 WA98201 CANC[LLED BY 7HE CITY UPON ANY STOPPAGE OF WORK ON iHIS <br /> Phone:259�8810 PROJECT OV[R 90 DAYS DURAiiON <br />