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Date�,fdr /� Pubhc Works Permit• aS <br /> � ` ����('o--�=�6 <br /> Application Fo: eie9.oeoi.+_ <br /> f'UBLIC WORKS PERMIT v�� �W��k=�0e <br /> iotalFee $ <br /> TO POSTING � z���L �essAnolFeevnina �o y <br /> Print or Type Only B��T��ao�a a �s <br /> ��, �,�� �x 7��3 F,.�,p� 9gaa/ as��,� <br /> Owner �— Mai mg Address City Zip Phone <br /> f�Lll N.A� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposetl Work �— ��.TI(�Y r n„ �p1,�1o1L.� <br /> Prolect Address lif known) ,v����Q� /v� -��� /T�IYY �� � � <br /> � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the fo'lowing as applicable: � <br /> • Property Lines � Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection sha;l be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit ard current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cal�Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> 7 �/iE 4lo.fSC SyqCL ,�OnNF �,e /Mf'•PESSioi✓ ,p�S�G.,,/ O <br /> �LANS A�leovE'o o.✓ /-/2-90. <br /> S, A BH���vATE� �,?�.�6.✓ron/ Y�'�v� r�vsr B� � <br /> Itis'.77uFo a�/ �9cc S:AE's�c✓�-,et_ � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe City ol Everelt irom any and all claims lor dainages. costs, <br /> "l expenses, or causes of action that may arise because of installation <br /> � /� ��g_ !J� �rd maintenance ot ihe improvement or other right-of•way use hereto <br /> G � auPlied lor and lurther agrees to remove same upon notice irom the <br /> Approved for Consiructj Date City and to replace�lic property damaged thereby. <br /> / \ G�� 7- Z2_ —5'/ _ <br /> FI� INSPECTION Date n O� <br /> Approved as Constructed Signature ol App icant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOFIZED BY THIS PERMIT MUST BE STAR7ED 'NITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THC- CITY UPON ANY STOPPAGE OF WORK ON iH15 <br /> PROJECT OVER 90 DAYS DURATIOh. <br />