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i <br /> i <br /> � <br /> - - - - � <br /> �' Date ll /�9/$� � � P��blic Woehe Permit• / <br /> . 7 / eiae.oew.. ���,�`F.�� <br /> ' Applicalion For <br /> PUBLIC WORKS PERMIT PubTotlFeeF1e = <br /> Le55 Ap01 FCC PA�U $ <br /> BalanCC Duc S_ <br /> � <br /> Print or Type Only <br /> /i /Z �SurAP}f' ���o� l �P��.idn/� ��/P/A� 9'c�Z_f_�; d5a-aya � <br /> , Owner Madmg Address Cny LP Phone <br /> . J <br /> ApplicaM Mailmg Address City GU Phone <br /> � � �-� /`nr ld/'� — <br /> � Describe Proposed Work <br /> W <br /> Project Address lif known) ��o� � �P�f�(�lb/`Q._ � <br /> - Atlach iour(41 copies ot plans for proposed work- Draw to scale and note Ihe Iollowing as applicable: � <br /> . � Property Lines • Centerline of streel � <br /> • Outline and dimensions ot all existing and • I�dicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> ' • Existing and proposeA utilities � Show measuremenis M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE O <br /> • PERMITCONDITIONS <br /> . i.All calls for inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work sha�l te pertormed in accordance with this permi�and current City ot Everett Design and Cons�ruction <br /> � Standards and Specifiwtions. <br /> .� 3.Call Location Urderground Service 4B hrs.belore you dig.TOLL FflEE NUMBER 1-800•424•5555. � <br /> ' � O <br /> I�0 I 1 ��,�'G6'�I I .� ��` � <br /> � ��e,t�L.fV1� I�-e- � <br /> . � �_ � -� � <br />�� - ; � � <br />�: , , <br />,: <br /> � � <br /> : ; <br /> . � ACKiJOWLEDGEMENT OF CONDITIONS <br />� . l The undersigned owner/applicant hereby agrees to hold and save harm� <br />� , less the Cily of Everelt Irom any and all claims for damages, costs. <br /> . � ezpenses, or causes ol action tl�at may arise because ol installation <br /> and maintenance of lhe improvemenl or other right�ohway use hereto <br /> applieA lor ai�d lurther ac�rees to remove same upon notice Irom the <br /> - Approved for Construction Dale City and to replace pu�lic property damaged Ihereby. <br /> FINAL INSPECTION �a�e Date <br /> Approved as ConsUucled Si9nalwe ol APPlican� <br /> WORK AUTHORIZ[D BY THIS PFRI+IIT MUST BE STARTED \NITHIN <br /> everett PUBLIC WORKS DEPARTMENT 160 DAYS OF DA7E PERMIT IS ISSUED AND TIiEREAFTC-R IS TO <br /> � 3200 Cedar S�reel BE DILIGENTLY PURSUED TO COMPLETION. TNIS PERMIT MAY BE <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7FII5 <br /> Phone:259•0810 PROJECT OVER 90 DAYS DURATION. <br />