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i <br /> I <br /> s � � <br /> �4 /--� /^� P�biit Wo�as Pe�mil� <br /> Y ' \ 9 /��((_ <br /> Date_ eiav oea� , �� 7�° I <br /> Applicatiun For ; <br /> PUBLIC WORKS PERMIT � <br /> Peblm Wor�e Foe � <br /> Toul Fec S— <br /> Less Ano� Fne PaiO S <br /> �aiance Due $ � <br /> Print or Type Only <br /> i <br /> V�r� G�LY�.15 'Lg07 n,2 0 , ��rr 1.�� 98201 � cR- �4b(, i <br /> - Owner Maihng Address Cdy LP Phone <br /> �Tar:-0 :.l�srEQa i''G $o.� 3l�'r�4.;,,..1� °S�o?� �8l - 7( 7/ i <br /> ApplicaM Mailmg Address C y Zip Phone <br /> � Describe Proposed Work �,��� 71l'�T li.�q COi.�G�7X' ���� �� . I <br /> 1 <br /> —Q/�sv,a�� T��k� ��7�e/TLlrL�= c.B.tiJoPY --- <br /> �/� {— t W � <br /> .. rroleC� Haares 1�� i � P/I�S Fa1TA)S 7lTJ/ C—��Q�T'� F`VL ��2E7T . � + <br /> Atlach lour(4) copies ol plans lor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines � Cenlerline ol sUeet � <br /> � Outlme and oimensions of all ezisting and • Indicate Norlh <br /> prGposed s�ructurea on tL� Ipt • Shuw aoy prepesPA prading change= <br /> • .xisfing and proposed u�ilities • Show measurr,men�s � <br /> DO NGT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> �� 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•5810. � <br /> 2.Ail work shall be performed in accordance with this permit and current City of Everett Design and Conslruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FRF_E NUMBER 1•800•424•5555. � <br /> �zC�� Gvor�y 1��� .t/o� .P���a� 3/7/e9 O <br /> �� � <br /> � <br /> � <br /> a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owner/applicant heieby agrees�o hold and save hann- <br /> less ihe City ol Everett IrOm any and all claims for damages, costs. <br /> expenses. or causes of action that may arise because of installation <br /> and maintenance ol Ihe improvement or other righPo4way use hereto <br /> applied for and lurther agrees to remove same upon notice Irom Uie <br /> Approaed lor Construction Oale City and to replace public property damaged Ihereby. <br /> FINAI INSPECTION Date Date <br /> Approved as Constructed Slgnature ol Applicant <br /> WORK ��UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTIY PURSUED TO COMPLET�ON. THIS PERMIT MAY BE <br /> Everett,WA 9A201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB10 PROJECT OVER 90 DAYS DUR�TION. <br />