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Date�CB'/$�{ �,,:,����-�.�sP�,�.:. 6 _ _ <br /> Application For d�ag Deot• _��23�11j_ __ _ <br /> PUBLIC WORKS PERMIT P�;o,rF���°� 5 ---- __ <br /> ��s=���� ����,.,,.� s <br /> Print or Type Only �'",°'.'Do° s — <br /> �a�Of,spn 5915 .C,Maisr;� l�/ �v�r�-H <br /> Owner Mail•ng Address City Zip Phone <br /> �Idl'7Yl��N01 �����Y Jl�d`cM/ 1��✓L7 ,f��-I�Sv/�,p ros 3 - as�� <br /> Applican� Mailing Address —T City � 2ip Phone <br /> 1 <br /> Describe Proposed Work l�QfX lh� _ <br /> c� W <br /> Project Address Iil known� Jl �(� 5 rc� �1t0/1 � <br /> Attach lour(41 copies ol plans fcr proposed work- Draw to scale and note Ihe tollowing as apP��Cahle: � <br /> �I • Property Lines • Centcrline ol street � <br /> { • Outlme and dimensions ol all ezis�ing and • Indicate North <br /> proposetl slrucWres on the lot • Show any proposed grading chanyes <br /> � • ExisGng and proposed utilities • Show measuremenis � <br /> I <br /> i DO NOT WRITE BELOW THIS LINE <br /> � PERMITCOND�TIONS O <br /> I 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8R1 O. � <br /> 2.All work shall be pedormed in accordance . dh this permit and current Ci1 i of EvereU Design and Construction <br /> Stand2!ds and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NIIMBER 1-800-�424-5555. � <br /> I O <br /> � � ' ��/��-e,�.,,,�N°� �'`.��`'� � <br /> � � � <br /> � � ����� <br /> /D��- 89 O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ov+ner/applicant hereby ayrees lo hold and save harm- <br /> �� � — less Ihe Clty of EvereU Iwm any and all claims lor damages, cosls. <br /> expenses, or causes ol action Ihat may arise because of inslallation <br /> and maintenarce of ihe improvement or ether righDol-way use hereto <br /> applicd for and lurther agrees to remove same upon nolice irom the <br /> Approved lor Construc�ion Date C�ty and to replace public property dama�ed th�reby. <br /> FINAL INSPECTION Da�e <br /> Approved as ConsDuctNr. Siqnatwe ol App6cant Date <br /> everelt PUBLIC WORKS DEPARTMENT WnRK �UTHORIZED BY THIS PERtv11T MUST BE STARTED WITHIN. <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 9A201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELIED BY THE CITY UPON ANY STOP�AG[OF WOfiK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />