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-r'- �z-z�-� � � <br /> Date_ 9 -Z7-90 Pu�lic Work�Garmil• , _ <br /> Application Por Biop.Depl.• � <br /> PUBLIC WORKS PERMIT P°°;o;F�eFe° � <br /> leu ROp�-�ee Peia S <br /> Balance Due S� <br /> Print or Type Only <br /> L/� �L� �y � L�v7�c� ll(oU7 -71��/ �. n.�n�.c�x�s Q�ZS� .>3�'/l��-�/ <br /> Owner Mailing Address Cily 2ip Phone <br /> (;vc�ca, I-��S �ccxn e n G a bvv� <br /> Applicant Mail�ng Address City Zip Phone <br /> Describe Proposed Work J1i�� � �—� <br /> wA W <br /> Project Address(il known) ��Z� , 1�L� ���� � ~ <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note ihe following as applicable: � <br /> • Property Lines • Centerline ot sireet � <br /> • Outline and dimensions ot all ezisting and • Indicate Nor�h <br /> propoced structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utili�ies • Show rneasurements � <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shail be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be performed in accordance with this��ermit and current City oi Everetl Design and Construction <br /> Standards and Specitications. <br /> 3.Cell Localion Underground Servir,e 48 hrs.before you dig.TOLL FREE NUMBER 1-800-4'l4•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigneA owner/applicant hereby agrees lo hold and save harm� <br /> less Ihe Gty ol Everett Irom any and all claims lor damages, costs, <br /> expenses, or causes of action that may ari;e because ol installation <br /> �_ n M ��_ — �_�t� :.nd maintenance ol ihe Improvement or other right-of-way use hereto <br /> �M-x ��� applied lor and lurther agrees to remove same upon notice irom t�ie <br /> Approved for Gon action /�— �a�e Cily and to replace public property damagetl ihereby. <br /> ��G��,. 3_ � _9� ,, � <br /> FINAI. INSPECT'ON Date � ���[.�" "'�' �� /� /3–�� <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everPlt PUBLICWOR�(SDEPARTMENT 1g0 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTLR IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PUFSUED TO GOMPLETION. THIS PEHMIT MAY BE <br /> Everetl,WA 98201 CANCELLED RY THE CIT'/UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OV[R 90 DAYS DURATION. <br />