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Date� BB—�%J8 <br /> P�ni��wo,ws re,mn. <br /> Application For a��a nan���_ ���__ <br /> PUBLIC WORKS PERMIT P��ULCWorkaFea <br /> Tote�Fee s <br /> LecsAppl feePeia s <br /> Print or Type Only Be�=�=�o�e s��-�— <br /> ���e,i./�nnla�M� �a �� So D;r����,�L_C�ntfl� �R'�aQ- 7bz z.3y� <br /> Owner MaJing Address Gty Z� <br /> P Phone <br /> �.�;, �p�P �, � �� � �,�l��ct- � � ��a -at�/� <br /> Applicant Mailing Address Cily ip Phone <br /> Describe Proposed Work __�1/P��) �(��P�C ��n2 PY L(y/ ���/p�,��s J�j�p J�K�� � _ <br /> �_�� <br /> Project Address(if known) �5�� ��C!/!�f/ , f � <br /> Attach fow(4)copies of plans lor proposed Wo�r�to sCale and note the following as applicable: � <br /> • Property Lines • Centerline of streel � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any propo�ed grading changes <br /> • Ezisting and p�oposed utilities • Show measuremenfs � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shell be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be pertormed in accordance with this permit and currenf City ol EvereB Design and Construction <br /> Standerds and Specifications. <br /> 3.Call location Unde,ground Service 4B hrs.before you dig.TOLL FREE N�MBER 7•800-424•5555. � <br /> � � c��.� 6.� c�,�2�7. �,�,0 �o�..-,� � <br /> da.�-,�' 7- zs -aa ��.�.G�►'>j �--- <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thc�.inde,igned owner/aUPi¢an1 hereby agrees to hold and save harm- <br /> " less lhe :ity of Everett horn any and all clalms lor damages, costs. <br /> ��� �z� B8 expenses. or causes of acllon Ihat may arise because ol installation <br /> � and maint?nance ol the improvement or other ric�nbof-way use hereto <br /> ap � tet nd urther agrees to remove same upon notice t�om ihe <br /> Approvetl for � ns r ion Date C y a to .e public propr.riy damaged thereGy <br /> - /�-lG -�y k'1-�(� <br /> FINAL INSPECTION Dale <br /> Approved as Constructed g �I�re ol Apph nt Date <br /> everett PUBLICWORKSDEPARTMENT �`K1RK AUTHORIZE Y THIS PER IT MUST BE STARTED WITHIN <br /> � 3200CedarStreet I 1fiJ DAYS OF DATF PERMIT IS ISSUED ANO THEREAFTFR IS TO <br /> h'veretl.WA 98201 8[ CIUG[NTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone�.2`9�9810 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> ��, PRGJF�;T OVER 90 DAYS DURATION. <br />