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� <br /> � �,� � 3�. <br /> �� �-7( PupLc Y�orMs Pe� <br /> DateS.&!.LO ��� '1-1� <br /> Appticatiun For eing occ�.• �<� <br /> PUBLIC WORkS �EF3MIT `'°"'°°'°""" -- <br /> ,a�A�Fa� s— <br /> �f'S5 AfPI FBP P.�'J S— <br /> .�� <br /> e.,�.,��:,,n�� — -- <br /> Print or Type C`nly — <br /> �.�u�cl ��� �or �� � ��rl� P�L� ,�r�r�''��� <br /> Owner Maiting Adtlress C�ty LF Phone <br /> h K �Z�J-�I�l_ <br /> AppGcant Mallin9 Atldress City Zip Phone <br /> Uescr;be Pro�osed Work �f—lG— � ��__�_L_��7p�JlLl�D� - <br /> - _ W <br /> Pro1er.'AAdress�il known� �`3� 7 - f�/'/l�:L �-�in,�iN P�- � <br /> Attacii fou�(4)copies ol plans lor proposed w�rk- Draw�o scale antl note the following as applicab:e: � <br /> • Property Lmes • Cen�erline ol street ♦^ <br /> O Outline and dimensions ol all existing and • Indicate Norih V� <br /> proposed struclures on the lo� • Show any proposeC grading changes <br /> • Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance wilh this permit and current City of Everett Design and Constmction <br /> S�andards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.befae you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � <br /> � <br /> N <br /> O <br /> a <br /> � ^�'.Y.NOVJ�ED�3[MENT OF CONDI110�JS <br /> � — The undersigned owner/applic2nl hereby a�rees�o hold znd save harm� <br /> — less the �ily ol Gverc�� Irom any and all claims for damages, costs, <br /> espenses, o� wuses o� action Ihat may arise because of installation <br /> ' ���� /�� / � �D and maintenanc< of the improvemenl or other right-obway use hereto <br /> �U_ �, �L1Df v �o / applied for and lurther a�jrees lu rem�ve same upon notice irom the <br /> Approved tor ConsGuction i Date Cityantl-to reflace public properiy damaged thereby. <br /> /% <br /> ����.�i 3-/G-/�o � �% (�. . '�=�"cc-c_ 7 � :' �F�, <br /> %_ - '— <br /> FINAL INSPEGTION Date — <br /> Approved as Constructed Signalure of Applicant ����' <br /> WORK AUTHORIZED Bl' THIS PERMIT MUST BE STARTED WIiHIN <br /> everetl PUBLICWORKSDEPARTMENT 180 DAYS OF GdTE PERtdIT IS ISSUED AiJD THEREAFTER IS 70 <br /> � 3200CedarStreet BE DIUGFNTLY PURSUED TO COMPLETION. �(HIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UFON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-881[1 PROJECT OVER 90 DAYS DURATION. <br />