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Dete�_ � <br /> '� <br /> wexc wonu w�ni ouYv <br /> Applicetion For ewo.o.�.• c? <br /> PUBLIC WORKS PERMIT wr;,;,�F» � �,o <br /> U..M0�F..PH� s�� <br /> Print or Type Only �.4�.o�. s ��� <br /> +as� �'i�/ <br /> �l�.fS .��fc,(�'�-TT 3//�A,f r r�-��7� � E� <br /> Owner Mailinp Atldress City ip hona ' <br /> JQ� �«Kw�.� �y�o .GtK/�� a �eQ �:�.� ���s �-s'9 i 7 Y 9 <br /> APPlicent Meiling Address CitY ZiP Phone <br /> Deecrlbe proposaC Work A�^c/l7GiO�L S`/��G�r �'jyynjL,y y��,� <br /> /�✓Ta «J �FiS'rc� <br /> Pio�act Address(if kncwn) � / � <br /> Attech tour(4)copiee ol plans for pro0osed work- Draw to ccaie and note;he lollowing as applicable: � <br /> • Property Linea • Centerline ol street � <br /> • Outllne and dimensions of all existing and • Indicate North <br /> propoled structu�es on the lot • Show any proposed grading changes <br /> • Exiating and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All cells for ingpection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and cu�rent City of Everett Design and Construction <br /> Standa�ds and Specificatio�s. <br /> 3. Call LocaHon Underground Service 4B hrs.before you dig.TOLI FREE NUMBER 1•800•424•5555. � <br /> y r���9,P,��� s,%��� ,��o��.e� O <br /> S' vr �iPi��G sT7�'s u,�c-c �.� Gs�c/�T�p <br /> oiJ s/7� � 3 ���'sig .��ra�,e sr ��/� <br /> .Cc�G 7.�E'� .Lr-/5�l�E l�ls'�c-�/l��I,T V� <br /> 6. /F �T���rri.�c sio� s�-�� is y�- � 0 <br /> ��o .559.���� � :� c�.r� ��r ,P�«i,e� a <br /> /f t�S'�S` Tj�r:�� �.�_ ��,c��� u�iT/fl <br /> '/ ��f /J' �{��� ACKNOWLEDGEMENTOFCONDITIONS <br /> he undersigned owner/appiicant hereby agrees to hold and save harm- <br /> lesu the Ciry of Everett from any and ell claims lor damages, costs, <br /> expenses, or causes of action that may arise because ol inatetletion <br /> and maintenance of the improvement o�other r'ight-of�way use hereto <br /> OVroved o� nah � n Date aPP��ed for and further agrees to remove same uDon notice irom the <br /> � Ciry and to replace public property damaged thereby. <br /> ��`������/��d-�- f6 G t� <br /> F L SPECTION " Datr , p � � �^� 1 <br /> Approved ae Constructed Si na of Ap cant Date <br /> everctt PLIBLIC WORKS DEPARTMENT O R12ED BY THIS PERMIT MUST BE STHRTEO WITHIN <br /> � 3200 Cedar Street 180 UAYS OF DATE PERMIT IS ISSUED AND THER[AFTEF I� 'f0 <br /> Everett,WA 90201 BE DILIGENTLV PUHSUED TO COMPLETION. THIS PE�RMIT MAV BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIiIS <br /> PROJECT OVER 50 DAYS DURATION. <br />