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(�_�� � 6�q a <br /> �ate�2_�� Pubtic WoiFa Por <br /> Appl tion For aiay o.a�.• <br /> PUBLIC W J KS PERMIT PubTOIeIFeeFeo S Z�3- <br /> less Aoo�Fee Pard S <br /> �rint or Type Only � � �'. g � ea�a�«o�a s <br /> N N � ty <br /> N � M � <br /> �-t�'Y'p � �C-�.�C'�;..����'�'� i,t.) I�l,i Gl,� _. <br /> Owner dm I�SiQ '��' Cdy ip Phone <br /> -��1 I^M �� � � � <br /> 7 ( I" / f� '" <br /> Applicant Mailing Address City 2io Phon= <br /> /"� n`,�/cyM <br /> Describe Proposed W�.k �,LSL�� r � � ' ` — <br /> ��-{� ^ W <br /> Project Address(il known) � ��"�` � � <br /> Attach fooi(4)copies of plans lor proposed work• Draw to scale and note th " wing as applicable: � <br /> • Properry lines • Centerline ol sireet � <br /> • Outline and dimr.nsions of all existing and • In�icate North <br /> proposed siructures on the lo� • Show any proposed grading changes <br /> � Existing and proposed uGiities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.A!I calls tor Inspection shell be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All v.ork�hell Ae performed in accordance with this permit and current Citv ot Everett Design and Construction <br /> Stendards and Speciticetions. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424-5555. � <br /> / �'._-� ,6��!f z�.. 1-�'",..7 �l�?.�I�j' _�/�,?i.-.� /��"%�-� O <br /> i - - <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> TI,e undersigned owner/appliwnt hereby agrees to hold and save harm- <br /> ", less lhe Clty ol Everett Irom any and all claims br damages, cosis. <br /> _ _:' _--. / ezpenses, or causes of action that may arise bewuse ol installation <br /> ^ `,'` `��"_� / /-.' �,�and maintenance of ihe improvement or o�her right-ol-way use hereto <br /> � �� applied for and further agrees lo remove same upon notice Irom the <br /> ApPiove r Constructi n Date City to repla Ulic propeqy damaged thereby. <br /> -���� �� � 6 � ��,I <br /> FI NSP TION Dat — <br /> Approved as Constructed SignaW re ol Arp. cant Data <br /> everett PUDLt�WORKS DEPARTMENI� WORK PUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFTER S TO <br /> Everett.WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANC[LLED BY THE CITY UPON ANY STOPPAGC OF WORK ON THIS <br /> IPROJECT OVER 90 DAYS DURATIOW. <br />