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Date ��e�,���o,�s a��m,�. — _— <br /> Oi�B Oe�l.• - __ <br /> Application For <br /> PUBLIC WORKS PERMIT PubTotiF�eFee g <br /> � 1155ApP��feePP�O S <br /> Baianca Duc $ <br /> Print or Type Only <br /> �vdRd� /ZGC1� � �s�SM C�.✓.6 /30/ I7ivP✓-6�l /2v4�2�%I 95'eL0 / �'3 '� —0 � 37 <br /> Owner Madmg Address City� Lp Phone <br /> j I�L-'<fJ ��"' �F�5 A� �'�-e / ��' ^c�-,) Srl <br /> �2i�f�C .�O [�/) NS�-*-'\ — <br /> Applicant �Mailmg Address City 2ip Phone <br /> Descri�� �roposedWork ���'� Slow ini l3AS6M6NT D/r /�"rNSO�v�C T.Fn^n�� p <br /> -,� �i/i� rorc o — �✓ f-niic�. � �flr/ 1G� .Z7, afl i �J /d <br /> / 7 7 1 <br /> �� -� .�/ s - ��oa ������.�- -� � W <br /> ProjeclAddress lit known� �� �( �va N'�" � <br /> Atlach four(4) copies ol plans for proposed woik• Draw lo scale and note the lollowing as applicable: � <br /> • Property lines • Centerline ol street � <br /> • Ouqine and dimensions of all existing and • Indicate Norih <br /> proposed siruCtureS on the lot • Show any proposed yradiny changes <br /> , � Existing and proposed utilities • Show measuremenis M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE O <br /> i <br /> i PERMIT CONDITIONS <br /> 1.All calis tor inspecticn shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current Cily of Everett Design and Construction <br /> S�endards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800-424•$555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLE�G[MENT OF CONDITIONS <br /> Thc undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City ot Everetl Irom any and all claims for damages, costs, <br /> J � ezpen5es, or causes ol action that may arise beccuse ol installation <br /> �� I (X/ C r//� and maintenance of the improvement or other right-ol�way use hereto <br /> �`������' '�� �— v ^ � ` applied lor and further agrees to remove 5ame Upon notice Irom lhe <br /> Approved lor CO struction a�e City and lo replace public properry damaged ihereby. <br /> Da�@ ! .�t-<�t �l !'-�2o(.L@,li` �/S' ���'' <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of App an <br /> WORK AUTH RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPFRTMENT 180 DAYS OF DATE PERMIT IS ISSUED AN� THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPP�GE OF WORK ON THIS <br /> Phone:259�8810 PROJEGT OVER 90 DAYS DURATION. <br />