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/9 P,^;,u <br /> � 87-79 <br /> Q ���/ u �� Publ¢Wor45 Permd• <br /> / / <br /> � � Application For eme.o�o�.• <br /> PUBLIC WORKS PERMIT PUbTotalFeeFce g <br /> �ess AOD�Fec PaiE 5 <br /> �- <br /> Print or Type Only oa�a�«o,�� s ��/"�'� <br /> F.�_ ��,�.c��E<' /33y3— �o�,Li� S�-r�icE .9G3-2.��/ <br /> Owner Mailing Address City Zip Phono <br /> l <br /> !�/�.L. O�5'.C�/_Firl ✓,ro.37- J'.3=�i9//c�. �rJ. E(/�",PET J�-�-�- y2SS/ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work <br /> f<< — jo voo ���5' ��� �s�=f'�' �l-�u <br /> Project Address(if known) s�3�� �G�'�lVc'�a`L� vE. � <br /> � <br /> Attach four(4) copies ot plans tor proposed work- Draw to scale and note ihr lollowing as applicable� � <br /> • Property Lines • Cenlerline ol street � <br /> • Outline and dimcnsions of all existing and • Indicate North <br /> proposed sirur.turea on thc lol • Show any proposed yrading changcs <br /> • Existinq and prunosed utilities • Show measuremenls � <br /> DO NOT 1VRITE BELOW THIS LINt O <br /> PERh11T CONDITIONS <br /> t. A�I cau, lor inspeclien shall be made 24 hrs. in advance• phone 259•8S1 5. � <br /> 2. All work sha!I be performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specilications. <br />. 3. Call Location Under�round Service 48 hrs. belore you dic�.TOLL FREE NUMBER 1-800•424-5555. � <br /> ���/'�'/ �'C J/r✓L�i'%�!'/L��' �Jl/��!�FG�, O <br /> � <br /> Y/ <br /> � � � � � � � <br />' P � fi0Q0245'9. � <br /> .:,. ,,., <br /> ���//l � � F f <br /> G I . �.� ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owoer/applicant hereby agrees to hold and save harm- <br /> less the Ciry ot Everetl irom any and all claims (or damages, costs. <br /> / expenses, or causes ot action that may arise because of instaltation <br /> T +� � ���/�� and maintenance ol lhe improvement or other righPol-way use nereto <br /> � applied for and lurther a rees to remove same upon notice�+ he <br /> A�proved fo- on;:t'ucjior� / � Dale Ciry and lo replace public9property damaged thereby. / 1/ <br /> �� � ' � r5 <br /> FINAL INSPECTION Date �/Z'�/� <br /> Approved is Constructed Si�nature o�AppGcan D e <br /> i.��i.�iq� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett. WA ng;?O1 BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> �,� � , ;�_ C�NCELLED EiY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � I P.OJECT OVEF 90 DAYS DURATION. <br />