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� <br /> Date �' / '� r\ Pu011c Works Permit n 87-- 295 <br /> Applicahon For BItlB.Depl.a �/,�,��� <br /> �� <br /> PUBLlC WORKS ��PEF�MI� P°o°�W��k=Fe� <br /> To���F�� s_ <br /> ., .. i�ssn�ni.F��P�m S <br /> Print or Type Unly a,,,���o„� s p oc — <br /> � <br /> o.�,.�nPl %�, ✓/PC�.., /��t`��(;,�)pin� f-��or,�� `y ,FJCI .�? � dy?C <br /> �Owner —��IingAddress i,iry � ' Zip Phone <br /> • J q ri�l 'Q- <br /> Applicant ' Mailing Address Ciry Zip Phone <br /> Descri6e Proposed Work � ' � " � i <br /> - W <br /> � �P�oicct Address(if known) �_ ` ' <br /> Attach lour(4) copies of plans for proposed work- Draw to scale and note 'ne following as aoplicable: � <br /> • P�operty Lines C� �;anterline of atreet <br /> • Outline and dimensions of all exi;ting and u Indicate North � <br /> proposed structures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities 6t Show measureinents � <br /> DO NOT WRI7E BEL04V THIS LINE � <br /> PERMIT CONDITIONS <br /> 7. All callc for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in acwrdance with this permit. and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service d8 hrs. before you dig.70LL FREE NUMBER 1-500-424-5555. � <br /> , � <br /> � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEA�IEN7 OP CONDITIONS <br /> / <br /> G� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett frnm any and all claima fcr damages, cosls, <br /> �---�,�/� expenses, or causes of aclion that may ariae hecause ot installation <br /> `��//, ,r��- and m intenance of the im rovemen! or other ri ht of-wa use hereto <br /> " �"-��/� `'� 2� �� auPliz� for and fuI her aqrees to remove ;amFr9 pon not�ce from the <br /> Approved for Construction ����P City d to replac9 Ublica Perty damagetl thereby. <br /> FIIdAL INSPEC?ION Date � � U V�"`'^� _ <br /> Approved as Constr�cled Si�nature of Applicant D• e <br /> everett PUBLIC WORKS DEPARTMEMT VdORK AUTHCR2ED BY THIS PERMIT MUST B- STAIiTED N�ITHIN <br /> � 3200CodarStrer.t 180 DAYS OF CATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br /> Ever��tt,WA 98201 BE DILIGENTLV PURSUFD TO CUMPLFTIC•�� -fHIS PERMII' MA'( BE <br /> ���une:250�D015 CANCELI.ED BY THE CITl'UPON ANY STUPF��,GE OF WORK ON THIS <br /> -- PROJECT OVER 90 DAYS DURATIGN. <br />