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/ <br /> Date_�3l���� ��b�,�wo�ksP��m,�<�^_ �7— �� <br /> Application For 91]9.Uept.x. 'V �/7;F��7 <br /> PIJBLIC 1iVOF�ECS PERMIT °°°;o�FceFea � — – <br /> Less AOC��Fee Pal� 5 <br /> Print or Type Unly e��a�«o�� s a0oo <br /> �ejl.�.�,��_[�Q I--f s� �1,�,.j-. %r.�•��: ��l�G.� �✓r•�Lif <br /> Owne Mailing Address � Cily Zip Phone <br /> �a��c) i�,�� P.!r��� a9ar�� - (r, �/f.2 vQ Alli� .S/n��it,o.f(' r5 .21�3 �c��i- �il�s- <br /> Applicant Mailing Address City �p Phone <br /> r � <br /> Cescribe Proposed Work �� Af�� � � I[+�)! � __ <br /> W <br /> Project Address(il known) 2-=��07�' /�ENlG lv�;,(tTf/ Pc. «�:r�z of ` <br /> /rfi'iu.�cv:N 's`� � <br /> Attach lour(4) copies of plans for proGcsed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street ♦^ <br /> • Outline and dimensions of ell ezisting and • Indica�e Norih V� <br /> proposed strucWres on�helot • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measu•emeMs � <br /> ; -� D� NOT WRITE BELC�4';THIS LINE � O <br /> � PERMIT CO^iDITIOMS <br /> . 1, All calis for inspection shall be made 24 hrs in advanr,e- rho�ie 259•$81 5. � <br /> e� 2. All work shall be perbrmed in accordance with this pennit and current Ciry of E�ereU L cs�3n and Construc[ion <br /> Standards and Sper,iliwlions. <br /> 'i 3. Call Locatien Underground Servir.e 48 hrs. befor�you dig.TOLL FREE NUMBER 1•800•424•55fi5. � <br /> f STREETS ARE TO BE KEPP CLEAR OF ALL MUD�GRAVGL,AND MISC. DEBRIS AT <br /> ALL TIMES, /� <br /> FAILURG TO KEEP THE PUBLI� RoO,W, FREE OF DEqRIS AND/MUD OR GRAVEL � <br /> WILL RESULT IN THE IMhiEDIAl'E POSTING OF A STOP WORK ORDER ON THE � <br /> PROJECT WHICH WILL REMAIN IN FO4CE UNTIL ALL CLEAN UP OF THE tt,O.W, � <br /> IS COMPLETED TO THE SA'PIo'FACTION OF TAE PUBLIC WORKS INSPECTOP. <br /> i <br /> � <br /> i <br /> � <br /> ACKNO'+:LEDGEMEN7 UF CONDiTIONS <br /> � The undersigned owner/_�pplicant hereby agrees to hold and save harm- <br /> less ihe City of Everett 'rom any and all claims lor damages. cosis, <br /> expenses, or cavees�of action that may arise because of installation <br /> ��,�:� f�. ' c�/ /,�.7 anA maintenancej� the improveme or other ric�ht-of-way usc here!o <br /> " 'x ���/f" ' /U `'� �� applied for an .further anrees t r ove same upon nolice Irom ihe <br /> Approved for'Cons�ruction /� / / Da�e City and to r lace public prop damac� ihereby. <br />- � -19 -F7 � � �� <br /> FiNAL IPISPECTION � � Dale <br /> Approved as Constructed Si ature of pli ant D e <br /> everelt PUBI_IC WORKS DEPARIMENT WORK AUT ORIZED BY TliIS PERMIT MUST BE STARTED WITHIN <br /> � 32(lOCedarStreet 180 DAY, OF DATE PERMIT IS ISSU�D AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILI NTLY PURSUED TO COMPLETION. THIS PERMIT Iv1AY BF <br /> PI',one: 259�8815 CANCELLED BY TH[CI1Y UPON ANY STOPPAGE OF WORK O!�TF' <br /> PROJ[CT OVER 90 DAYS DURATION. <br />