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Date� �:' � :?�. Z9 -S <br /> romm woas rermn. <br /> � Application For eiaa.o�ai.. <br /> PUBLIC WORKS PERMIT Publ¢WorxsFee <br /> Total Fea S <br /> LC55 FOP�FP!PB�C S <br /> Print or Type Only 8aianceDue S <br /> ��k MU�►�-� �� o� � Cg.��� ����-- �a� i a5-�a�67 <br /> Owner Mai{ing Atldress City Zip Phone <br /> R��k �vs_� a�o2 � c��� �����,- i�i, ��aa � �sa-a� � � <br /> Applican Mailing Address City Zip Phone <br /> DescribeP1\roposedWork M� � S l�P`'S_ 11L.`L1Jn �+P�OV�� �1 � t.N��v�N4 fi <br /> N�tW NDM�, O N C�NZ O\ `��1�\ �H�pJ 1.��0U �c� �t�` 10 ll HS <br /> m �� ��l � r � � � T � h� t,�1 0 �s Ja <br /> a k a W <br /> Project Address(if known) +�.�U� � �V i��� WAS ���U� � <br /> Attach four(4)copies ot plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outiine and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed graAing changes <br /> • Existing and proposed utilities • Show measurements � <br /> DQ NOT WRITF RFt_OW THIS LiNE <br /> PERN O <br /> �.nll c 2, /- QS ione 259-8810. � <br /> 2.All v '� ind current City of Everett Design and Construction <br /> Stai <br /> , 3.Cell �OLI FREE NUMBER 1-800�424•5555. <br /> 5�,�� ���J` °F Z <br /> nC i-i'"' � 7� (G O <br /> P��,,�;,y �s�.; �� �1 � <br /> � <br /> �li«�=d <<���,« ,� ,� 0 <br /> ?nC� ���� �C✓ 7 �'e� � <br /> liL/O U�� G74 1iG �o G�U <br /> Q�'UC[ SS pc: La v5�° � � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> -S�CF�i� -s��'P`'"" The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe City of Everett trom any and all clains for damages, co,ts. <br /> =xpen;es, or causes of action that may ariso because of installation <br /> and maintenance ol the improvement or other right-of•wey use hereto <br /> �F � 3pplied for and turther agrees to remove same upon oatice irom the <br /> Approved for Construi ;ity and to replace public property damaged thereby. <br /> FINALINSPECTION <br /> Approved as Construc iignature ol Applicant Date <br /> PUBLIC..vnnoucrr�nlMtNl vVORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ���� 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.TH�S PERMIT MAY BE <br /> Phona:259�8810 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />