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i <br /> PUU16 Wa�ks Pe�uul a " /_ �� � <br /> D9ii��23/91 oing.ocot�_91/%�B�XX 26307 <br /> Application For _ <br /> plJ�LtC WAF�KS PERMIT °°�;o„F�o"" S — <br /> LessFpO�FeoPa� 5 �QOO <br /> Balance Due g <br /> Print or Type Only <br /> MGreat Northwest Const. 2721 116th St SE Everett 98208 337-7153 <br />� Mailin9 Address C�ly Zip Phone <br /> Owner <br /> Owne� <br /> Applicant <br /> — Mailing Address City Zip Phone <br /> Oescribe Proposed Work New c <br /> �.aa 9 9ta — --- � <br /> Projecf Address(if known) <br /> �3iHHf—Howarl Ave. �u�3 � <br /> � <br /> A�tach lour(4) copies of plans tor pioposed work- Draw to sca!e and note the following as applicable: � <br /> • Property Lines • Centerline of street <br /> O Indicate Norih <br /> • Outline and dimensions of all existiny and e Show any proposed giadin9 cnanpes <br /> proposed struc�wes on ihe lot � g��o,;� i�Qas�rements � <br /> ! Existing a�d proposed utilities <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> t.All calis Ior inspection shah be made 24 hrs.in advance-phone 259•8810. <br /> 2 All work shall be pertcrmed in accordance with this permit and current City o7 Everetl Desinn and Construction <br /> Slandards and Specifications. � <br /> 3.Call Localion Underground Service 48 hrs.befnre you dig.TOLL FREE NUKBER 1-80Q-424•5555. <br /> � <br /> � <br /> � <br /> � <br /> 9o�i0 <br /> ACI(NOWLEDGEPdEIJI OF CONDITIONS <br /> /,�//� The undersign�d owner/applicanl hereby agrees to hold and save harm- <br /> �+`� — less the Cily of Everett Irom any and all claims for damages, costs. <br /> expe�ses, or causes of action thal may arise because of inelallation <br /> �,// � and �naintenance of ihe improvement or other right-of�way use here�o <br /> <�iS'n/��y� a—ir-9� appliad for and further agrees lo remove same upon notice (rom the <br /> � � Date <br /> �pproved for Constru ti , City md to replace public proper�y dama�7ed lhere6y. <br /> -�����//� s-i3 -�r �, � -�z -9� <br /> FINAL INSPECTION � Date Date <br /> ApProved as Consiructed <br /> Si�ma�ure of Applic�nt <br /> WORK AUTHORIZED BY ThiIS PERMIT MUST 8E STARTED <br /> I eveiet[ PUBLIGWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAPTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PER�SI"f MAY �E <br /> Everell,WA 98201 CANCELLFD BY THE CITY UPON AIJY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJ[CT OVGR ?i0 DP���S DURATIOPI. <br />