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� <br /> D2i'. �� � � v��m�r wo��s a�.�mn. ... -----._ _. <br /> Binn nepi . ��C� /� � � � � <br /> App�icalicn For --"—+-- ����J�- -- <br /> PUBLIC WORKS PERMIT ��°°°°W°��=F°e <br /> Tm,�Fe� S --- — <br /> Less moi Fe«Va�a $ <br /> Print or Type Only e,�,�«o�� s. __ <br /> �jN a II� Curn L� �/So9 �.. C-'i a e��w f- ��in /=✓e�nrf 9.�4'Zo�, a'S�-�/Gcfi� <br /> Owner Mailing AC ress Cdy Lp Phone <br /> � GC11NI 1 <br /> Applicant Mailing Address City Lp Phone <br /> 1 j� ,� / <br /> Describe Proposed Work �C-� /�((� �: /'O��f l9/71/,L� <br /> � / / <br /> ProlectAddress�ilknownl _— ��� ��S['PNT /K✓��_ � <br /> � <br /> Attach fow�4�coples ot plans lor proposed work� Dra�v to scale and note Ihe following as applicable: � <br /> • Propeny Lines • Cenlerllne ol streel � <br /> • Outline and dimensions of all existing and • Indicale Norlh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls tor Inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be perlormed in accordance with this permit and current Cily of Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> �(J�L iL C�JO�C'.t_S f��,e/rIi i A/o� ,�c C��r•E'f�� O <br /> c�f'�,�' �- <br /> 8- �� a9 (� <br /> � <br /> a <br /> �CKtJOWLEDGEMENT OF GONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> — less Ihe Cily of Everett hom any and all claims for tlama9es, costs, <br /> eapenses. or causes ot action Ihat may arise because ol installation <br /> and maintenance of the improvement or other nghPof-way use hereto <br /> applied for and further ag�ees lo remove same upon notice Irom the <br /> Appwved Sor Construction Date City and to replace public properly damaged lhereby. <br /> FINAL INSPECTiUN Date <br /> ApProved as Construcled Signalure of Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireel 180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,VlA99201 BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />