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% <br /> Date��'q �,��,�,�wo,..<<,.,m�,�.p 8��SZ � <br /> ApUlication For ein� Den� � __�/1_Ey,.,17 'nj__ _ <br /> PUBLIC WORKS PERMIT ������<<�ra�^=FCe � --- — <br /> i To�:,���„ s-- -- <br /> sx dnul Fce Pa¢1 5 <br /> Print or Type Only e'��,_:�o_� s �7�� <br /> I��, � I�y r—p l� ,� / � % /.' t1 hr� =�v'e /_�;Piatf Q�26/ l S2- �%D��S <br /> Owner Madmy Atldress City Zip Phone <br /> S4�11 p GB/10/8S 4:3:tP14 GUOqbi339 I:C:Y.:B <br /> i <br /> Apphcant Afailin[�Atldress Ci� — <br /> Y ZiP ��i)I��SE�; Phone <br /> PW FL' �12,D�7 <br /> Descri6eProposedWork Y1N�U iVll �� -l/)Q�17��10_, ��.�TWSP a�75 nn <br /> CHECI; k87.00 <br /> F-olecl Addre55(if knownl � Z � / � <br /> At1a^.h four(4) cop.Es of plan5 lor propoSP.d work� Drav� lo scale antl nofe the following as applicable: � <br /> • Property Lines • Centerlin�of street � <br /> • Outline and tlimensions ol all eaisting and • Indicate North <br /> proposed siructures on the :ot • Show any p�oposeA 9rading changes <br /> • Ezisting anti proposed utilities • Show measuremenls � <br /> DO NOT VVRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance witn this permit and cu«ent City ol Evered Des�gn and Consiruction � <br /> Standards and Speci�ications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> T, p�iL(,� � �2 O�O�z.Li �CQ/e� �e'v G%�E%�1� O <br /> � �i Ct'f� oW s-•a -B9 (�,o�� ct�`rz�e�� <br /> 2f ul3GiC c�la�c^,ES !)GPT. � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned o�vne�/applicant hereby agrees to hold and save harm� <br /> Iess tHe City ol Everetl Irom any and all claims for damages, costs. <br /> _�/• �J� ezpenses. or causes of action that may arise because of installatioi <br /> r ��,l�� ��. ��=�8p and maintenance of Ihe improvement or other righl�ol�way use herelo <br /> � applied lo� and lurtlier a rees to remove same u on notice Irom the <br /> Approved lor Con r tion Dale 9 � <br /> Ciry and to replace public U«Perty damaged thereby. <br /> � / �9 <br /> �, � /L -�� f�•i � �!. <br /> FINAL INSPECTION Uate � ^ L� a ' O— g <br /> Approved as Constructed Sign,Wre ol A licant <br /> Date <br /> everclt PUBLIC WORKS DEPARTMENT WORK AUTHO . ZED BY THIS PERMIT UST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 99201 BE DIUGENTLY PURSUEO TO COMPLETI0�1, THIS PERMIT MAY B[ <br /> Phcne:259�8A10 CANf,[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />