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f' <br /> Date_��7 ' 1� �` PoEIieWorksPermn♦ �� �� <br /> Application For BItlg.Depl.+_��1(�9Jr <br /> pUBLIC WORK� PFRMIT PubllcWmkaFee <br /> To�a�Faa s_ <br /> Less Appt FUe Pela S <br /> Print or Type Only Ba1a �qo�a S Za�b _ <br /> Ce�e U);I/n�c�sf �33D� w„ �1 EoL�dnnds 48oao ��5-�9i.2 <br /> �wner Mailing Address City Zip Phone <br /> �M� <br /> Applicent Mailing Address City Zip Phone <br /> Describe Proposed Work /v� e�1 -Si���/� '�1Y1�lu (P.S/ /�Af•(J <br /> �—cJT 6 �/'P1l�i�JlY(�� <br /> ProlectAtldress���known) lbZ� — Ev�/h00� L/1/, La7sb' .,f' � <br /> C.Qe'lTL�.M00. � <br /> Attach four(4)copias of plans lor prnposed work- Draw to scale and nole ihe following as applicable: � <br /> • PropeAy Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North �� <br /> proposed structures on the Iot � ShoK•any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> �� <br /> DO NOT WRITE BELUW THIS LINE O <br /> PERMIi CONDITIONS <br /> 1. All ceils for inspeclion shall be made 24 hrs in advance• phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with this permit and curreni City of Everett Desiyn and Construction <br /> Stendards and Specifications <br /> 3. Call Localion Underground Service 48 hrs.before you diy.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDCiEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold ar�d save harm- <br /> '� Ir:ss the City ol Everett irom any and al� claims for damages, costs, <br /> � expenses, or ca�ises ol action that may arise because of installation <br /> ' /i' � // anJ maintenance of the im rovement or other n ht-ohwa use hereto <br /> �%L �IJ�'� /i/8� P �J Y <br /> Approved tor ConstrJ t � Date applie�and lurther agrees to remove same upon notice from the <br /> City a replace publ:c property dimaged thereby. <br /> 1/'%� � / <br /> FINAL IN ECTIO� 3 �/ �l pate �' / / 'S � ✓ y <br /> Approved es Constructed ignet of Applicant Dete <br /> ?verett PUBLIC WORKS DEPARTMCNT WOHK AUTHORI2ED BY THIS PEPMIT MUST BE STARTED WITHIN <br /> ` � 3200 Cedsr Slreet 180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED DY THE CITY UPON ANY STOPFAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />