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Da1 e� �~� � � Pu�Lt NIO�kS PE�m�I p• � <br /> Appli�Bticn POr sieg Dept•��_pZ.�j.��_._ . <br /> PUBLIC WORKS P�RMIT �°°�,�w°.�=F�e <br /> ,o�r�Fe� s_ <br /> Lus>P0� Frr Pz�J S <br /> Print or Type Only � " , °` S— ---- <br /> --IY�G_,�, � � l�l�r�r � � �r./S lsi���- F ���iT/ QF zo/ zs2 -4�`Q7 _ <br /> Owner � Pdading Atldress Cdy Zin Phone <br /> 1Y1��Yl �6�,��'��,� /�o da�,s�n ,��r�,iiP 9 �a��� ,�v.Sg�a� �/ --- <br /> Apphcant � Mailing Atldress �� Cily Zip Phone ' <br /> DescribeProposedWork N�NI I�iAN��ayl_�j(�L]!" PK'/S/`i _Y1a (Zi�i�(�� <br /> J <br /> J '� <br /> Prolect Address lil known) 7 ��rj K��iO'1�r � � <br /> Attach lour 141 copies o� plans for proposed work- Drav;to scale and note the following as applicable. � <br /> • Property Lines • Centerline of sUeei fA <br /> • Outline and dimensions of all existing and • Indicale Norih V� <br /> proposed strucwres on the Iol • Show any proposed grading chanye=_ <br /> • Ezis�ing and proposed utildies • Show measuremeNs � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEIiMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•$810. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and ConstrucLon <br /> Standards and Specilications. <br /> 3.Call Location UnderqrounC Service 46 hrs.heire ynu dlg.TOLL PREE NUMBER 1-800-424-5555. � <br /> � r � <br /> �!!�� CJ���/� � � -�=�!��,=i' ,�: � <br /> � /-� �.� - fi;��.� �' <br /> `�,�� /�9�9 � <br /> � <br /> �. <br /> i.CKNOWL[DGC-MENT OF CONDITIONS <br /> The under.;iqnnA owner/npP6cant hereby agrees�o hold and save h.�rm- <br /> --- -------� �-� -�-1 less the City of Evered from any z.nd all cla��ms for damages, eosts, <br /> rrpenses, or causes of action ihat may arisr: because of installalion <br /> and mamtenance ol ihe improvemenl or other iigh�-of��vay use herelo <br /> applied lor and further agrees Io remove same upon notir.e Irom the <br /> �uProved for Consiruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date — <br /> Approved as Construr.ted Si�nawre ol ApPlicant Date <br /> rcrrelt PUBUC WORKS DEPARTA4ENT WORK AUTHOHIZED BY iHIS PERMIT MUST 8[ STANTED WITHIN <br /> 3200GedarStreet 180 OAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT G4AY BE <br /> I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PRpJ[CT OVPR 9(1 DAVS DUR�TION. <br />