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Date � // g6 <br />Appticalion For <br />PUE3LIC W�R'"S PERM�T <br />Print or Type Only <br />Meiling <br />s��,� <br />Applicant Malling <br />—G�S���!/vf �1/ts! . <br />i�ess citv <br />iress City <br />Zip <br />Zip <br />r�eu�wo���a�,�m�i. �'�' Zi�9 <br />eiaq.oem.._ �,� t��c�'7— <br />Pu�llc WadeFco <br />7aulFea S _ <br />Lefa Aoo� Fno Pn1tl S_ <br />eninnconue ; '��7 00 <br />Describe Proposed Work NE[.c% S��r/GGE� Fi9m.� s/ ,<'EJivcn/GF <br />Prolect Address (it known) S�� � — <br />Attach four (4) copios ol plans lor proposed work • Draw �o scale and note the lollow�ny as applicable: <br />• Property Unes • Centerline of street <br />• Outline and dimen;ions ol all existing antl • Indicate Norlh <br />proposed structures on the lot • Show any proposed gr:. 'ing changes <br />o F,cisUng end proposed utilities • Show measuremen!s <br />PERMIT CONDITIONS <br />1. All calls for insp=ction shal� be made 24 hrs. in advance - phone 259•881 °. <br />2. All work shall bu pertormed in accordance with this permit and current City of Everett Design and Conslruction <br />Standards and Specilications <br />3. Call Locatir•� Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-SOJ•424•5555. <br />� A��`L 7I'U <br />�=,'Lu-.�GF�'oc�n-- 7�9/�i� <br />Approvedf rConslru � Date <br />/ <br />, ��� '�-1 Y �j <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everelt PUBL�C WORKS D[PARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8815 <br />ACKNOVlLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ot Everett Irom any and all claims for damages, costs. <br />expenses, or causes of action that may arise because ol installation <br />and maintenance ol the improvement or other righPol-way use hereto <br />applied for and Iwther agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />/YC'-cc �.rf �c�/1��,�i C--- <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />