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�'r . , - <br /> Date��'� � W,��,�,<<�,�,k.�•,.,�,p�. —... / <br /> APPlica!ion For ��no o��m , .[�-L�G�•rti�-CL�._ _ . <br /> F�IBLIC WORiKS P�RMJ1` r����w�,�=F�� ------- <br /> ,o�:,�Fe� s_. <br /> Lessnnn� �m�vam $ <br /> Print or Type Only ❑��,,�".n�., s <br /> CPN� f-aSl9P%�f1 ��a�j �'��� m� c� �VP�F 7�2Q 3 �7–/.3! 7 <br /> Owner Maihng Address City ���� <br /> Fhone <br /> Sn ✓vt �- <br /> Applicant Mailing Address City :iG Phone <br /> DesCribe Proposed Work � _,f'��[Q�q // <br /> r ra� ! "" �L��,---�-�, e" — <br /> Proiect��ddress Iil known) _ I /� O�_/�, � � <br /> Attach lour(4) copies ot plans br proposed work- Uraw to sc� antl note the following as applicable: � <br /> • Property Lines • Centerline ol sUeet � <br /> • Outhne and dimensions ol all existing ancf • Indicate Norih <br /> proposed structares on the lol • &hov+any proposed yrading changes <br /> • Ezisting and pwposed utihties • Show measurements � <br /> DU NOT WRITE BELOW TF!IS LWE Q� <br /> PERMIT CONDITIONS V <br /> 1.All calls for inspeclion shall be made 24 hrs.in ada�nce-�hone 259•88�0. � <br /> 2.All work shall be performed in accordance with this permit and curren�City of Everett Design and Construr,tion <br /> Standards and Specification::. <br /> 3.Call Lur,ation Underground Service 48 hrs.before you tlig.TOLL FqEE NUMBER 1•800•424-5555. � <br /> �� /,, e .) � f � <br /> /�-�GciGU�.v/�i:s,�r � /��,� %C'j,C�t/�t c� <br /> �� L���� /' � <br /> f" <br /> � � -�� � <br /> Q <br /> � <br /> ACKNOWLFDGc"fd[Nl 'JF COkDITIONS <br /> _ _ _ ___ The undarsiqned owner/applicant hereby agrees to hold and save harnr <br /> Iess ihe City ol Evere�t Irom any and all claims lor tlamages, costs. <br /> exUen;es, or causes of aclion that may arise because ol inslallation <br /> and maintenance of ihe nnprovement or other rigrd-ol-way use hereto <br /> applied lor and lurther agrees to remove same upon notice Irom Ihe <br /> ApUroved lor Conslruction Date City ar.d to repl�ce pubGc property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approvetl as Construr,ted Signature ol Applicant Uate <br /> everett PUBLIC WORKSDEPAflTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 32CDCedarStreet 1b0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERA1IT MqY B° <br /> Phanc 253�8810 CANCELL[D BY THE CITY UPON ANY SfOPPAGE OF WORK ON THIS <br /> PROJFGT OVER 90 DAYS DURATION. <br />