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...R,,, <br /> �� _ 1 �zs��- PubimWorAaPo�mil• � ` '�� <br /> Date Li 9/ r ` �l..F <br /> Blae Oeol.�� <br /> qpplication For <br /> Pl1BLIC WORKS PERMIT `'°°''°`"°'"„`° 5 <br /> TolalFca <br /> � �� Z G —�� �ess APO�Feo✓a�J S O � <br /> Tp POS�I��6__�----�—� ao„�coo�o 5� <br /> qH Print or Type Only ��afP r, ���v�'�� �" <br /> � � � <br /> p �Q � O er Mailing Atltlress � *h CItY Zip Phone <br /> '�~ '��'! S �5 -7sc3 <br /> U7 N <br /> � x 3 �` Mailing Address City ZiP Phone <br /> p � Applicant <br /> H /� r_ <br /> ty in1��� �nwi/l 11Gp ` �-[1-�Z ' <br /> � C�i7 O Descri6e Pwposed Wbrk � ���`�'- <br /> �i]Y �] <br /> � �� � <br /> ri H . _ <br /> ti � <br /> H <br /> n d y prolect Address(il known) 58�9 C'� �L-'1v'fI:UOC�- - ve -- — <br /> � c� r � <br /> � Anach lour 14)ropie: of plans lor U�oposed work� Oraw to swle and note Oie following as apPlica�la � <br /> H O fyA • PwPerP. Lines • Centerline o�street <br /> • Octline :nd dimensions of;dl eaisting and • Indicate North <br /> proposed sirucW res on the lot • Show any proposed gradin9 chan9es <br /> � • Existin9 and PwPosed ulilities • Show measuremenis M <br /> DO NOT WRIT[BELON�THIS LINE O <br /> 1 <br /> I �� PERMITCONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance•pho :2b9•8810. <br /> 2.All work shall be pedormed in accordance wi�h lhis permit a��u current City of Everett Desi9n and Construction <br /> � Standards end Specilications. � <br /> 3.Call Low�ion Jndergwund Service 48 h�s.belore you dig.TOLL FREE NUMBER 1-800•424'S555. <br /> i O <br /> I � <br /> � <br /> I - � (� <br /> � �_ O <br /> a <br /> __. <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> � � Thr.undersigned owneqapplicant hereBy aqrees to hold and save harm- <br /> less Ihe Cily ol Everelt irom any and all cWims lor dama�es. costs, <br /> eapenses. or causes ol action lhat may anse because ol inslallation <br /> r"'� k'G��`� p _z��Q/ and mainlenance ol ihr improvement or clher •i9hPobway use herelo <br /> .I J� J � applied lor and lurtner agrees to remove same upon no6ce Irom the <br /> Ap�d lor Cons E�ion Date City and lo rep�ace public properl maged t .reby. <br /> ���/�`l� io -��- �' ` -- -_' -`i� <br /> FINAL IN PECTION Date Date <br /> qpproved as Constructed SignaWre o IicaN <br /> WORK AU IZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � ��i.�i.�� PUBUCWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> O 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 � CANCELLED BY THE CITY UPOM ANY STOPPAGE OF WOFK ON THIS <br /> Fhona 259�8810 PROJECT OVER 00 D�1YS DURATION. <br /> ✓ <br />