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% <� /1� ✓ <br /> DateY.C-i—��� 1 Public WO�F3 P!mmi /�1l �/-7�]yy4�'(/ <br /> Bi�g DeOt• ._�1 - —�-�/—J— <br /> qppliCaticn For � <br /> PUBLIC WORKS PERMIT �°°'�°"'°""°° -- --- - -- <br /> ,o�a�F�� s_ <br /> ��ss aoo� ve•.Pma 5_�� <br /> oniance Dur 5 �� <br /> Print or Type Only — <br /> C�-�.mQ����[,- '`��,,a�► �U �� �aOJ ,�� �1�3� �77�d 1� <br /> Owner Maihng Address �ty ZiP Phone <br /> �-�-�ay-rq� ,��r-�d������`�'� _ <br /> Aaplicant Mailin, Ad ess Gly Zip Phone <br /> Describe Proposed Work �1__:�."AAL�`�!'�ti��t--a��� ' --- <br /> —�`« <br /> i � <br /> i <br /> ' �S_F. G�Ui=.�c"'i%/�7ACG t�.9f/. � <br /> Pro�ect Address 01 known) �� — <br /> Attach fow(4) copies o� plans lor proposed work� Draw lo scale antl note the lolloviing as apUlicable: � <br /> � • Properry Lines • Centerline ol sirect � <br /> '' • Outline and dimensions of all existing and • Indicate North <br /> j proposetl structures on Ihe lol • Show any proposed gradmg changes <br /> � • Ezisting and p�oposed utilihes • Show measurements � <br /> i <br /> I <br /> ! DO NOT WRITE BELOW THIS LINE O <br /> ( PERMITCONDITIONS <br /> 1.All calls lor inspeclion sha�l be made 24 hrs.in advance-phone 259•8810. � <br /> � 2.All work shall be peAormed in accordance with this�ermu and current City ol Everett Design and Constructlon <br /> { Standards and Specifications. <br /> I 3.Call Location Underground Service 48 hrs.before yeu dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> �� �r �,C�r�v-�'� ��+ns �>,�� �' -�5/-P�9 � <br /> i/ <br /> � <br /> � <br /> �r{ � /�9 (e�q � <br /> ,���t� � a <br /> a3a6� <br /> ACKNOIVLEDG[MENT OF CONDITIONS <br /> The undersi9neG owner/applicant hereby agrees to hold and save harm� <br /> – –� less the Cdy of Everet� irom any and all claims lor damages. costs <br /> ��� eapenses, or causes el action Ihat may arise because ol installation <br /> � /� and maintenance ol the improvement or other righl-obway u<_e hereto <br /> �'t _ applied tor and furiher agrees l�remove same upon notice Irom Ihe <br /> qp ( v d nst ucti �a�e City and to replace public property damaged thereby. <br /> p �, �.. . � � , � <br /> � �. <br /> !� ,vc �� <br /> FINA- INSPECTION � Date � �n — Date <br /> Approved as Constructed SignaWr O pph N <br /> WORK AI�THOR ED BY TNIS PERMIT MU B STARTED WITHIN <br /> everett PUBLICWORKSOEPARTMENT `�gp-0;NS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evcrelt,WA99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-0810 PRUJECT OVER 90 DAYS DURATION. <br />