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4� �-. <br /> Punbc Wo,xs Peimn. <br /> Datc�� ��� 7/ <br /> a��g Deo�-� <br /> Application For �� � <br /> PUBLIC WORKS PERMIT Puhl¢wcrksPee <br /> ro�T� -�e � <br /> u!ssnoo FerPauf 5 <br /> Pa',:mcc flue 5 <br /> Print or l ype Only <br /> ��.�'/- -�rh � J 'L 71��-G�� /�A��Pr/iie !J__�!L-�IFId�A� 7��5 7.s���Y9 � <br /> � !haiLng Aadress C��y Zip Phone <br /> �� �'�r111 ���5 ']7�IG /U.C—Ci�7���-r'f/f� /O/�� �C27�L17//i/ <br /> , Iican����Y Mai6ng Address City Zip Phone <br /> PP <br /> D=scribe Proposed Work ��QfQQ11���r � ���et—�`{�j��/�� <br /> ��9 r T���.�� LJ.I <br /> Proleci Addr�s;Iil known) � <br /> Attach lour(4) copies ot plans lor proposed work- Drav+to scale and note ihe lollowing as applicaole: �d <br /> • Prope:ty Lines b Genterline of street � <br /> • Outline and dimensiuns ol all existing and • lndicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ex�sting and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE o <br /> PERMI�f CONDITIONS <br /> 1.All cedis for inspection shall be made 24 hrs.in adv:�nce-phone 254•SS10. � <br /> 2.All wodc shall be pedormed in accordance with this permit and current City ot Everetl Design and Gonslru�!ion <br /> Standards and Speci(ications. <br /> 3.Call Localion Underyround Service 48 hrs.befo�e you dig.TOLL FREE NUMBER 1•8U0-424-b$55. � <br /> � l; . .�j /� _ _'`�✓ � <br /> � �Gi � � �! -r.v�-'� /_. . <br /> � . _ , . . , . ���/!: �,.c'��-- � <br /> .. _�"' ��C � <br /> O <br /> a <br /> ACKNOWLEOGEMEI.i vF CUNDITIONS <br /> The undersigned owner/applicant herr.by agrees lo hold and save harm� <br /> less Ihe City o1 EvereU from any and all claims lor damaqes. costs <br /> ezper.ses, or causes ol action that may arise because o� installahon <br /> and mantenance ol ihe improvement or other riyhbof-way usc hcreto <br /> appiied lor and further agrees to remove same u1>on notice hom the <br /> Approved ior Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECI"ION Date —p.���,— <br /> Approved as Constructed Signalure of Applicant <br /> WORK AUTHURIZED OY THIS PERMIT MUST BE STAF3TED WITHIN <br /> everett PUBLICINORKSDEPAATMENT 180 DAYS OP DATE PEHMIT IS ISSUED AND TNEREAFTER IS 70 <br /> I �� i 32pnC�tlarStreet BE DILIGENTLY PURSUED TU+70MPLETIGN. THIS PERMIT MAY B[ <br /> UEverett,WA 99201 CANCELLED BY THE CITY UPC^i ANY STOPPAGE OF WGFK ON THIS <br /> Phone:25P-8810 PROJECT OVER 90 DAYS DURAI�QN. <br />