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Date�9 '�- ' 9S OZZ ! <br /> PuD1ic Work�Perm�t e <br /> AFP�icafion For eiao�o.u�.. <br /> � ' PUBLIC WORKS PERMIT P�����won�Fee <br /> Totel Fee s <br /> Llis�ppl Fe!P�ip � <br /> Print oi Type Only ����uDw •�A— <br /> 7Y�3-SSG (A <br /> L.�sT3o..� �Ev % Jqc.k C'o� �ir/ I 3�i�w - �lb �-bF.. S� �'r,co�-lsm� 1J�1 <br /> Owner MaiNng Add�ess City Zip Phone <br /> �'I���a� Ja��L -� 8a.� sEee�ra 4(o S�tr,7.� wA 16'/�s� �ry � ��� <br /> APP����— Me�ling Address City Lp Phone <br /> Describe Proposed Work ��-Q�� � P <br /> �i�Z rn u r..1 .�rc P . "�A� L � <br /> Project Address(if known) ��^"��f� �' P,? c� ?�Q/— PG , � <br /> Attach four(4)copies of plens fo�proposed work-Draw;o scale and note me lollowing as applicable: T'��v nNti/ ' � <br /> � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimenaions of all existing and • Indicate North <br /> proposed atructures on the lot • Show any proposad g�aAing changes <br /> • Existinp and propoaed utilities 0 Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspectbn shell be mede 24 hra.in edvence•phone 2Sa8810. � <br /> 2.All work shell be pedprtned�n eccadance with this permit end curcent City of Everett Design end Conetructlon <br /> Stendaroe end SpeclNcationa <br /> 3.Cell Location Underpruund Service 48 hn.before you dip.TpLL FREE NUMlEII 1-800-4Z4•55�5. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City o� Everett irom any and all cfaims for damages, costs, <br /> � e�penses, or causes o1 action that may ariae because of installation <br /> �� 9/� and maintenance of the improvement or other right•of•way use hereto <br /> applied for and further agrees fo remove same upon notice irom the <br /> proved o Co s ction Date City and replace public property damaged thereby. <br /> �.�X � - 3/_lr'/� ' p l/ <br /> FINAL INSPECTION ,�ate C��C.!✓�/ ��� /�S— <br /> Approved as Constructed Si ature of Applicant Date <br /> � PUBLICWORKSDEPARTMENT WOR ORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStreet 180 �AVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 88201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />