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y�yl9� - � - � -za-9- .._ <br /> Pu�IIc Worb Por@y• �( /'� <br /> Date��� �i � �� <br /> ' ApplicalionFor eie9.oeP�., � � ' <br /> PUBLIC WORKS P�RMIT P°°��°K.°�k=F�a -- , <br /> Toi:�Foe s <br /> Les9 FCO�Fec fa�d S '� <br /> BalanceDue S �O <br /> Print or Type Only I <br /> I CE,vI �' ' - P.O .I�-A�C-U��1�7 �p t�q 4Q��Ane� l���-��Cr.(�L-- I <br /> Owner � Mailing Address City Zip Phone <br /> Applicanl Mailin9 Address City Zip / JPh��_� I <br /> i <br /> Describe Proposed Work �Q _� I <br /> � <br /> 2p A-t3 G-� LErt�vaOP A�/CHVE W <br /> ProjectAddress�ifkncwn) �+����'^�t�[f��T � <br /> v <br /> Attach four(4)copies of plans lor proposed work• Draw lo scale and nole the lollowing as applicable: r <br /> • Property Lines • Centerline of slreel � <br /> • Outline and dimensions of ail existin� and • Indicate Norih <br /> proposed stiu�tures on the lol � Show any proposed gradinq changes I <br /> • Ex�sting and proposed utililies • Show measuremenls � <br /> ��� DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITiONS O <br /> t.All calls tor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All�vorl.shall be performed in accordance with Ihis permit and current City ol Everett Design ard Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> O I' <br /> � �I <br /> � I <br /> O I <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hureUy agrees lo hold and save harm� <br /> — - less ihe City of Everett irom any and al; claims for damages, costs. <br /> ��� �/J/p/ ezpenses, or causes of action that may arise because of installation <br /> and mainlena e of the improvement or other ri�ht�obway use heretc <br /> � 'T.—' appli 1 r lurther ac�rees lo remooe same upon notice irom ihe <br /> Approved for Con truction Date Ciry n � ,e �ce public proper!y damayed thereby. � <br /> ��1�� �^/'�-9/ � <br /> FINAL INSPECTION Date - <br /> Approved as Construcled Signature ol pplicant Date <br /> WORK AUTHURIZED BY THIS PERMIT MUST BE STARTFD WI7HIN <br /> evere[t PUBLICWORKSDEPARTMENT 1g0 DAVS OF DATE PERMIT IS ISSUL"D AND THEREAFTER ��-70 <br /> � _ 3200CederStreot � � BE DILIGENTIY PURSUED TO COMPLETION. TNIS PERMIT M <br /> Everett,WA 98201 CANCELLED BY THE CiTY UPON ANY STOPPAGE OF'NORK O' <br /> Phone:259�8810 PROJFCT OVER 90 DA1'S DURATION. <br />