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� � � <br /> O� x <br /> �� M _ ' r�oi�c�vo��;�mmn. -- <br /> rc <br /> '` y� Date�,35�s'J � _�j �1• (n t <br /> Flitl� oco� • <br /> �N �� Applicalion For <br /> L �' " PUBLIC WORKS PERMIT P����c�VoiksFoo S <br /> f7 � � io�ai Fco — <br /> C'1 <br /> Loss PDO�Feu PaiC 5 <br /> 0 H d Baianco Oue 5 <br /> .(b.� � g Prinl or Type Only <br /> �I]Y (7 <br /> E� y� , �. `� .� 'z � ' 3 3-�`J'�I <br /> �y H � C Mailing Address Ci�y 2ip Phone <br /> Owner <br /> M & �- W <br /> C] l7 V. / e <br /> �c� � �� � � 0�7 �`—��M�HP� ��1� ��F 15n''` LI%GC4f/il U��� Q D oZ �1�� P one <br /> Applicant Mailing Address Ciry 2ip <br /> HOf�i� <br /> Describe Proposed Work -�n P� 1 S�D�1/�� <br /> W <br /> Proiect Address(it known) � <br /> � <br /> Attach four(4)cop�es of plans lor proposed wo�k- Draw lo scale and note the lollowing as apPlicable: � <br /> • Property Lines • Centedine ol sVeet <br /> • Oulline and dimensions of all existing and • Indicate Norih <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> ' ; PERMITCONDITIONS � <br /> � 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. <br /> 2. All work shall he perlormed in accordanca with ihis permit and current City of Everett Des�gn and Construc�ion <br /> f�1 Standards and Specilications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLI FREE NUMBER 1•800•424-5555. <br /> 1 ' ��U��� Cl�'7�'� �C�h7ii /�.�n%��QCL.CL`-� p /�,5' -.�7 O <br /> j ��`�� I- <br /> �'i O <br /> ,_, a <br /> _� <br /> '�1 ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrtes to hold and save harm- <br /> '.�1 less the Cily of Everett Irom any and all claims for damaqes, costs. <br /> e•penses, or causes of action lhat may arise because o� installalion <br /> - and mamtenance of the improvemenl or olher right�of�way use nmeto <br /> applieA for and lurther agrees to remove same upon notice trom ihe <br /> Approved tor Consl�uction Date City and to replace public pwperty damaged thereby. <br /> FINAL INSPECTION Date Date <br /> ppproved as Conslructed <br /> Signature ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIT <br /> �evrrcll PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> I 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> UEverett.WA 98201 CANCE�LEJ BY 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />