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1�- 8�29 —5 � v <br /> Date���9/> Pu�hc Woi�a Pe�mi <br /> � <br /> oina.ouo� • �-�-- <br /> Applicalian For � _ <br /> PUBLIC WORKS PERMIT� Pu��icWa�hSFoo s _ <br /> Tolal Foc <br /> Le�aFOD�FeaPela S <br /> x [] O O O s g BalanceDun 3��� <br /> Print or Type Only � � o o �n N <br /> .-� ,o ,o -� <br /> �, » " <br /> � � � M <br /> S ' ��/�za�! �5'�- 4rG'� <br /> wner Mai ing Address �Ci � Phone <br /> 0 <br /> �Q ✓P l��n � (�o �` yia G- ia� �`' S�- r� �v�PJ _ <br /> Applicant Mailin9 Address City Zip Phone <br /> DescribeProposedWork �A/f/ r�Aa�� ���'/� D�� <br /> � _ - W <br /> Prolect Address lil known) 53O ���-G�"FUC Y� PAT�"1 _.— � <br /> Attach four(4)copies of plans lor proposed work• Draw to scale and note Ihe lollowing as applicable: � <br /> • Property lines • Cenlerline of street � <br /> • Ou�line and dimension� of all exi5ting and • Ind�cate Nor�h <br /> proposed s�ructures on�helot • Show any proposed grading changes <br /> � Existing and proposed utiGties • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor inspection sh���i 5e made 24 hrs.in advance•phone 259•8810. - � <br /> 2.All work shal!be peAormec'm accordance with this permit ana current City o!Everett Design and Construction <br /> S�andaids and Speciticetions. <br /> 3.Call LocaUon Underground Sen�ce 4B hrs belore You dig.TOIL FREE NUMBER 1-800�4?4•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACrtJOWL�Di?E.t�ENT OF CONDITIONS <br /> —/1 The untlersigncd owneriapG��cart hereby ag�ees to holtl antl save oarm- <br /> _`�-- �ess ihe Cily ol Everetl irem any and all claims lor tlamac�es, costs, <br /> expenses. or causes of action that may arise because of installation <br /> and maiMenance of the improvement Or other nght-of-way use hereto <br /> ��QQ /('�Z 3��U opplied lor and �uriher apree; to remove same upon not�ce Irom ihe <br /> Approved lor Cons r ion�� Date I City anc to repl.�ce public property damaged thereUy. <br /> F/l'l` 3— ��'_�� —_ I /�'' ,� '� � <br /> -- - /'• ,. -;ta�—�e� 11-5 -90 <br /> f �NAL INSPECTION '''�` � --�" �—�""—, fiate <br /> „pproved as Constructetl �,.�r �t��r�: ot AUPlia�nt <br /> WG��ri AJiNORIZED BY THIS PEFMIT MUST BE STAR'ED WITHIN <br /> everett PUBLICVlORKSDEPAR7MENT �g0 GA/S OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireel BE DI_IC�NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 9B2ot CAPICELLED B'f THE C�TV UPON ANY STOPPAGE OF WORK ON TFIIS <br /> Phone:2`A�B810 PRWECT OVER 50 DAYS DURATION. <br />