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�'�,t'��n �lr�.n��y !r-�3-8e <br /> rr c5'7—i�3 <br /> �8te�1/ � •�/p•• Pu�l¢WorksPermil+ <br /> -�'� � �F7 �/82n � <br /> eiec.000i.•�---- <br /> Applica�ion For <br /> PUBLIC WORKS PERMIT PubTo�Foe�eB S <br /> �ase noP�Fee aa�a S �O� <br /> ealence oue S <br /> ?rint or Type. 7nly I <br /> -��. �F ,� r�F�os� 3� 7 -_� 9a l ' <br /> lo_ ;, 3s�ocSo n �-iZ9 - ��—Q/ �'✓on <br /> Owner Mai�ing A�idress City 2ip Phone <br /> Applicanl Mailing Address Ciry Zip Phone I <br /> ` I e ��:-�.�L�i cus-� �iv� C rp<f Ln� � ! <br /> Describe Proposetl Wcrk n e�A r e� n <br /> — s��� W <br /> Prolect Addres�,:(if known) � �� C��ESi �� � <br /> Atta�h tour(J)capies of plans lor proposed work• Draw to scaie and note the following as applicable: � <br /> • Pro�erty Lines . • Centerline of slreet � <br /> • Ou:line and dimensions of al�existing and � Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. AII calls for inspection shall be made 24 hrs in advance•phone 259•BR1 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specitications. i <br /> u. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> i <br /> 1J.e,vE�y fo,e rr�,s c��- ��.5.- � BE f'.�vF.o <br /> j,�0� T1/F �7.F'EEy T� Tis'E p•Pc�E•z� G//�/�. O ' <br /> � <br /> � C'O�j/ O� S.s�/•IrivTcvt/ PE��niT Fo2 L7.P•9iN jE[v � <br /> /f�tl� S�PriG rSN/.� h9L�ST BE Tu.P�J�'O /.�/ 7o yf/E O <br /> �[/iCOiNCr .�F�T. [3FfaaPE�/�E.P��TS� h'.F'F /SS!/_fs? <br /> d����o,.vo- � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned oerner/applicant hereby agrees to hold and save harm• <br /> —�— less the City ol Everetl from any and all claims for damages, costs, <br /> expens , or causes ol action that may arise because of installation <br /> /� A `f— 2�/g7 and ma en�nce o( the improvem2nt or nther right-of-way use hereto <br /> �//� Oa'yyY applied r and further agrees to remove same upon notice from the <br /> /lpproved for nstru ' � Date City and replace Aublic prop.rty damaged thereby. <br /> -� �a-�-�_ , �-_.�-- �C� . �,� <br /> FINAL INSPECTION Date • — Date <br /> Approved as Constructed :i nat.re Applican! <br /> WORK THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> e��erett PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF VJORK ON THIS <br /> Phone: 259•� '5 pROJECT OVER 90 DAYS OURATION. <br />