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� �'�i: PunucWo�ksPerm�i� <br /> Date_' �> � <br /> ApUl;tation For Biaa oco� • ��J �3 `�G 7- �_ <br /> PU��IC WORKS PERMIT Pu�IrcWaks�ee <br /> iotal Fee £ <br /> Leis RpD� Fee PaiO S <br /> BaiancP oue 5 <br /> Pri�it or Type Only <br /> � �-�C � f[ <br /> csz-�Fsy <br /> 'I' c_ � .%C-L-2�Lc�. /%'S' ' y G✓�..�[. /�l:--r .�''a.-.-,.i/-� �-,ac✓a-,�-.e. S PG f z- <br /> Owner Mailing Adtlress �City Zip Fhone <br /> !�f..:�X/.✓ — <br /> ApPlicant Mailing Addrecs City 2ip Phonc <br /> Desc�ibe ProGased Work �4M' ('���.G�-' <br /> ��1 W <br /> P�o�ect Address Id knownl �6d�?O J%/��-'�-�-�`-*'"� �'�+/ � <br /> Attach lour(4) ropies o� plans for proposed work- Draw to swle and note the follow�nq as applicable�. � <br /> • Properry Lines • CenleNine ol sireet � <br /> • Outiine and dimensi�ns ol zll existin9 and • Indicate Norih <br /> proposed structures on Ihe lot • Shov, any propo,r,tl gradmy chanyes <br /> • Ezisimg and p�oposed utilities • Show cieasurements � <br /> DO NOT INHITE BELOW�fHIS LINE O <br /> P[R(d1T CONDI1lONS <br /> t.A!I calls for insped�on shall be made 24 hrs.m advance-phone 259•881 Q � <br /> 2.All work shall he performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specdications. <br /> 3.Cail Location Underground Sernce QY. hrs. belore you diy.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> 1 �7 <br /> � - 1 ; , r. �Jc�_1—� �;2a-,-,�JS- �C,c�� - <br /> '� V♦ <br /> �-��y�l1-�-�- �-�-- --- � <br /> Cr-- z s-- `���' I d <br /> L.� <br /> ACkNOWL�DG[MENT GF GONDITIONS <br /> Thc undersrgned o��neVapplicant herehy agrees to hold a�d save harm� <br /> ------- -- --- � le�s the City of Everetl irom any and all claims lor damages, costs. <br /> expenses, or causes ot aclion that may arise because of installation <br /> and maintenance ot tYe improvement or other nghFobway use hereto <br /> ` _ applied lor and furihe� aqrees to iemuve same upon noi�ce hom the <br /> �, Pi,r>roved lor Construction Date Cily and to replace pubhc property damaged thnreby. <br /> i <br /> �FINAL INSPECTION Date <br /> �� ppr.ved as Construqed Signature of Applicant Date <br /> ���.��q� PUBLICWORKSDEP�RTMENT WORK AUTHORIZED OY THIS PERMIT MUST BE STARTED WITFIN <br /> � 186 DPYS OF DATE FERMIT IS ISSUEP AND TNEREAFTER IS TO <br /> 3200CedarSlreet BE DILIGFNiLV PURSUED TC COMPIETION. THIS PEPMIT MAY 8[ <br /> Everett.WA 98201 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phune,259�£;B10 PROJECT OVEH 9G DAVS DURATION. <br />