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Datc� /7 f�y <br /> ryJrl'rG r,�— PUULCNaMSPermp. 89—�.J`_/_ _ <br /> Application For —f-�/ oia� peP�.. <br /> PUBLIC WORKS PERMIT P������W�«=F�a — <br /> iotnlFee �_ <br /> L2s5 Appl.FBC PdiC � <br /> Print or Type Only o�����eo�� s ..2U�-- <br /> �E�E/ SE�GEGs� �XS/�� .�,ll,� Se�dl�l7 9BZSB °J���OBZ� <br /> Owner Mailing Address C�ty Zip Phone <br /> .SG„�r Q� _n1oa�: <br /> Applicant Mailing Address Glty Ap Phone <br /> Describr, proposed Work �. Zt��— �� ` �� <br /> � � — <br /> L.��v�w.�� ' r�� Fu.-/ Sin/C+LE FAinit r/ hLin-iE <br /> � <br /> Pic�ectAtldress�ifknown� �/�8 ,�/(/��iyJ.�O/j �n• �/�� � <br /> Attach four�4) copies ot plans lor proposed wo�k- Draw to scale and note Ihe follow,�g as applicable: � <br /> • Property Lines • Cente:line of street � <br /> � Outline and dimensions of all existing and • Indicale Nor!h <br /> proposetl structures on the lol • Show any proposed grading changes <br /> • Existing and proposed utililies • Sliow measuremenis <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls lor inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be peAormed in accordance with ihis permit and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBEp 1-800•424-5555. <br /> ��i �LC/ ��� �' �� Cl�GG �'LLri��/Y7.Gc1 � <br /> ,Ge �o`G��. Sze ��, r'����, � �-,,,0� � <br /> ���� w��� -� ��� � <br /> � <br /> L(�cx�/' S P.✓rcL O <br /> p, �-1;� � .s,�c�e.. a <br /> / � "� �� ACKNOWLEDGEMENT OF CONDITIONS <br /> \ ndersic�ned owner/applicant hereby agrees to hold and save harm- <br /> ,/ the City of Everett IrobQ,�k/Qqd $1:3�}�spBQpqBQ�s. Gl�# <br /> ----1`L�/ ""— ' JY / /"/ o,Nenses, or causes ol ac�n that�may arise because of installation <br /> f /�� ��ZZ I and maintenance of the im rouh��p� other right-ol-way use hereto <br /> Approved for Conslruclipn a�e aPPlied tor and further ac�re��nn��1''r �ibe��,arm, upon notice irom the <br /> ` / Cily and to replace public prvpe�q�damagQ6YN�by. <br /> ��.�i �-- ���-�O CRSH 520.00 / <br /> FINAL INSPECTION � � ,/j /� '� � <br /> � Date �� . ��G/� <br /> Approved as ConStruCled Signature of Applicant ��7 Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> Everelt,WA 9g201 BE DILIGENTLY PURSUED 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 OURATION. <br />