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- <br /> Date�d�—�C� Pu�bc Wode�emel• �� ^�/� <br /> , <br /> � Application For aiae o�p�.. <br /> PUBLIC WORKS PERMIT ��b;o,eFBpF�� $ <br /> Loss AypL Foe Paitl S—�— <br /> Print or Type Only � �a�a�=o o�0 5_�_ <br /> : <br /> ani �, AG+`ni�l� 370�' G��i�r�r� �/�. ,�r/�i��! �3'Pi�l 1,S'�=33/G. <br /> Owner Mailing Address Cily Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> D/e/scribe Propo�:�,ed Work / /L� /.7i`I��iu �ll�'�� //> ��i��� L�l/r�J AD�n,� <br /> 7"J�� S�fl.s B/G F/L L T' <br /> Project Address(il known) � 7 .(_. _ � <br /> Attach four(4)copies of plans lor proposed work• Draw to scale and nute the lollowinc�as apolicable: � � <br /> � Property Lines • Cenlerline ot slreet � <br /> • Outline and dimensions ot all existing and • Indicate Norlh <br /> propos^d slructures on the lot • Show any proposed gratlin�changes <br /> • Existing antl proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00-424•5555. � <br /> y ,�c�S/oN ccr!'�/�7� �r_S' C�/��c'/�� <br /> ��/ //1�C.�'�C2 %J� . O . <br /> / <br /> �', '/��<<C`��/ % /�=zf��.�S'/2�G �'� /`z�j� � <br /> ����/�� cS/�Cc%� �� �i9�� � <br /> 12/31/90 4=42PM OOOFlq5106 :� <br /> 6' �'� ���'�� S�i�j�045549 /� <br /> dPT.20 559.20 li <br /> CHECY, f59.20 <br /> ACIWOWLEDGEIdENT OF CONDITIONS <br /> The undersir,ned owner/applic 7nt hereby a9ree5 to hold and save harm- <br /> less �he Cdy ol Everett irom any and all claims lor d2mages, cos�s. <br /> � expenses, or causes ol action that may arise 6ecause ot installation <br /> �a�� and maintenanr,e ot ihe improvEment or other righFol-wny use hereto <br /> _7�T ` appl�ed tor and lurther agrees �o remove same upon not�c? hom Ihe <br /> Approve or Cons ion Date City an�W replace public property maged lhereby. <br /> � L � <br /> i / �i / <br /> FINAL WSPECTION Dale � ��Z �l-�� �JJb�C�K /�—����L� <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WO�iK AU7HURIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br /> � 3200CedarS�reet 180 DAYS OF DATE PERMIi i:; �SSUED AND THEREAFTEN IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY PE <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 CAVS DURATION. <br /> � <br />