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Date�,��/�' �9$ — 207 <br /> � r�m��wo,�s ne,mA�i. <br /> AFFlication For e�eB o�o� •—iL���� <br /> PUBLI�. WORKS PERMIT PubecWodeFce � <br /> Totel Fee g <br /> Less Ao��Fec Paia � <br /> Print or Type Only 8����=���_ s �� <br /> �.��", � � 17a � r_=�a/�„ �r� ���o�a� ��aa �3 9S�F 9 <br /> Owne Maihng Atl ess Cdy Zip Phone <br /> Sa M � <br /> � Applicant Mailing Address City Zip Phone <br /> Describe Proposed VJork . /VQtn/ /��i�1�P�� r n� � �� ,���f � � ✓p /�„ �/S <br /> � KC F <br /> �a i I 1 Jc�2 9 fi� a 8 �ldrNkJ000 �!/� � <br /> Pro�ec�Address il known � <br /> Attach fow(4) copies ol plans lor proposed work- Draw lo scale and note the following as apphcable� � <br />;�� • Property Lines • Centerline ol street � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed siructures on ihe lot • Show any proposed grading char,ges <br /> • Existing and proposed utiGties • Show measuremenls <br /> i � I <br /> DO NOT WRITE 6ELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All ca�ls for inspection shall be made 24 hrs.in advence•phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current C�ty of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FPEE NUMBER 1•800-424•5555. � <br /> / O�(/C� �i�//�67C9r�� ALi�.S'S 2� u�i.OF. <br /> ��i2ivgway.jAl/d�' /r/� tviD�' Pe''.� Sya.e-�`P�.4�' p�Di.rh�N�J � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneNapplicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett Irom any and all daims for damages, costs. <br /> .�-�,(�����f— 8 eapenses, or causes of aclion that may arise because ol install2lion <br /> �f� � �r�/�a and maintenance of ihe improvement or other right�ohway use hereto <br /> Approved lor Con ruChon �pplied for urlher agrees to remove ame upon notice twm the <br /> ate City an o repl pu6G propert am etl thereby.� <br /> �� ��i--- �/y % <br /> FINA INSPECTION Date <br /> Approved as Constructetl ai . ure ol p icant <br /> Date <br /> everelt PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA g8207 BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION, <br />