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i <br /> , <br /> nate��9' F„��,�wo,,,P�,m�. _�'1���'2— <br /> Applica�ion Fo� emo Deo� • �.�s�/ )� <br /> PUBLIC WORKS PERMIT Pu��¢1YorhaFee - <br /> totnlFee S <br /> Ll55�p0� FPP PpiE s <br /> Print orType Only Ba�a�=eo�� s �C'.� <br /> J�cv��. �-- �i e I G'.3�a �'lN '� pE �veMtl� ��zo 3 7 y.3-�378- <br /> Owner MaiBng Address Uly 7ip Fhone <br /> So�,e <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��uQn/r ('¢y��/,� np�� � j R r—„�Q�,, U+Qh ; <br /> � J. - a��.:�. /��' , <br /> I <br /> Project Address lii known) � ��� � �= �/,/I/�/ �p � �� <br /> A��aCh foW(4)Copies of plans lor proposed work•Drav.�to Sca��e and note�he following a5 applicable: � � <br /> � Property Lines • Cenferline of street � <br /> • Outline and dimensions of ell existing and • Indicate North <br /> p�oposeA struclures on the lot � Show any proposed grading changes <br /> • Existing anA proposed utilities • Show measurements � , <br /> DO NOT WRITE BELOW ThI1S LINE <br /> PERMITCONDITIONS O i <br /> 1.All calls for Inapection sbell be made 24 hrs.in advance•phone 259�8810. � , <br /> 2.All work shsll be peAormed in accordance with this permit and curreM City of Everett Design and Construction � <br /> Standerda end Specifications. � <br /> 3.Cell location Underground Service 46 hrs.before you dig.TOII FREE NUMBER 1-800�424•bSSS. � I <br /> O � <br /> � ' <br /> I <br /> � ' <br /> O ! <br /> � <br /> a <br /> ��jO ACKIJOWLEUGEMENT OF CONDITIONS <br /> The undersigned ovmer/applicant hcreby agrees to hold and save harm� <br /> less the City of Everett irom tny and all claims for damagr.s, costs. <br /> � /�� � ezpenses, or causes of action that may arise because of installation <br /> � and maintenance o� ihe improvemeM or other ri hFol-wa use hereto <br /> A `-- J�i��•�� �'T /� �- applied for and further agrees to remove sameupon notYce irom the <br /> pproved for Constru tion Date <br /> City and to replace public property damaged thereby. <br /> ai-G �-.7 r -� ���`1 <br /> FINAL INSFECi10N �pa�- �t.�w�' ,�� � �j <br /> Approved as Consiructed Signature ol ppiitn� Date <br /> everett PUBLIC WORKSDEPAqTMENT WORK AUTHORiZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAY:, OF �ATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DtLIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WnRK ON THIS <br /> I PROJECT OVEF.90 DAVS DURATION. <br />