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_ � . <br /> �. <br /> � ^ �� _ �� �v � Publ¢WorksPerm�it� __e=��� <br /> Date� .�, <br /> � � - Bmp Deo�.�—9 <br /> qpplication Por <br /> PUBLlC WORK� PERMiT P�01¢Worksiee S <br /> ,o,a�F., <br /> Less Appl Fee PeiO s <br /> �— <br /> Baience0ue S �� <br /> Print or Type Only <br /> IVka 7 1.�✓o.i� +ttr;J; /cZ5 —' S5� �-1/i1Ht.UCfla-L_ v1/�— 7'�S —R"8'q � <br /> ^ Mailing hddress City Zip Phone <br /> Owner <br /> nti� ���,,,� �- i�3� iog'^.ty- ru� �✓a.�r,� S��an� �� 3�i �--a��2 <br /> qpplicanl <br /> Madmg Address Ciry ip Phone <br /> Describe Proposed Work �1*� S� �UlH���i(N�,�fS �S�� �� 4N r/i]!H✓/_'r� <br /> W <br /> Prolect Address 1if known) <br /> �90� Mc�.�� N Avice ~ <br /> � <br /> Attach tuur(4)copies of plans for proposetl work- Draw to scale and note the following as aoplicable�. � <br /> • ProPerty Lines • Centerline ot street <br /> � Outline and dimensions of all existing and • Indicate North <br /> pruposeA siructures on ihe lot • Show any proposed grading changes <br /> • Ezisting ard proposed utili;ies • SYow measuremeMs M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shell be made 24 hrs.in advance•phone 259�8810. <br /> 2.All work shell be pertormed in eccoitlance with this permit and current City ot Everett Design and Construction <br /> Standards and upecifications. � <br /> 3.Call Locallon Underground Servicc 48 hra.before you dig.T04L FREE NUMBER 1•800�424•5555. <br /> 2.PAVliADRIVBfiAY$FROMUPROP6RTYPLINE TOASDGSfiOFIPAVSDNROADDWITHwAY O <br /> ASPHALT C6M6Ni. � <br /> � <br /> O <br /> a <br /> ACKNO'.NLcDGEMENT Of CONDITIOt'1S <br /> The undersigned nwner/applicant hereby agrees to hold and save harm- <br /> less the Cily ol Evere�t ircm any and all claims for damages, costs. <br /> ���/' expenses, or causes oi action that may arise because ot installation <br /> � n _/ �/ � and mainlenance ot Ihe improvement or other righl�ol-way use hereto <br /> '1`(�u � �'{ � C� ' � ��'" � � � applied ia and turther agrees to remove same upon notice Irom Ihe <br /> hpproved for Constructior / � �a1e City and to replace putrlic property damaged thereby. <br /> � / � <br /> �—+�%�:,��'�� �'�,�`' �`� ��� 3 - Z g�`� � <br /> FINAI INSPECTION Date Dale <br /> Approved as Consirucled Signature ol ApPlicanl <br /> WORK AUTHORIZEC� BY THIS PEFMIT MUST BE STARTED WITHIN <br /> everett� PUBLICWORKSDEPARTMENT 1II0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br /> — I 3200 Cedar Street BC DILIGENTLY PURSUED TO COMPLETION. TNIS PERMIT MAV BE <br /> �� Everett,WA9B201 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> V� Phone:259�881C PROJECT OVEF 90 DAYS DURATION. <br />