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/ <br /> PubhtWmMSPermlt. 90 - yz� <br /> I �,� <br /> Date � (l e�ae oen�.• —f�.S`�(�[� <br /> Application For <br /> PUBLIC WORKS PERMIT PubTonlFee�Be S <br /> LessA00� FeeCaiJ $ <br /> oaiancco�e § ?QOO <br /> Print or Type Only <br /> _ LP �� a6 � i s �+ - - - � ; , ,}. �,- ,� <br /> � <br /> Owner Maiting Address City Zip Phone <br /> qpplicant Mailing Address City �ip Phone <br /> Describe Proposed Work �.,A i�1 !� ��)lQ� P. ��`f1%1L / l�� <br /> i <br /> W <br /> Prolect Address(if known) �`3'3O — � ~ <br /> Attach tour 14)copies ot plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> � Property Lines • Centerline cl street � <br /> • Outline and dimensions of all existing antl • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PFRMIT CONDITIONS <br /> 1.All calis for inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> St3nderds end Specitications. <br /> 3.Cell Location Underground Serv�re 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> f� ��{�}r,� o�ow�s�w�rfs slxE[C 6e cv;tir.ocfeo� t-o f�.'s O <br /> fioosc's Sidi' SGCJE'!: <br /> : J s� !L d�'ivet�/�.f/ Cuf,Der `�t�/ S�{q n d�,ro�S . Da �,of � <br />' /jr,oc,F om faP o�F/ C��r6 �v �•�sfall — .Per�ove cvr� <br />� LBTCCI �� O <br /> � y��r ��M� / `� o <br /> �� �,�\q.a a <br /> Q � � <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> The undersigned owner/applican�hereby agrees to hold and save harm- <br /> less the Clty ol Everett from any and all claims lor damages, costs. <br /> / ' expenses, or causes ol action that may arise Uecause of installation <br /> �(/ r��J /� D �/vO and main�enanCe ol Ihe improvement or olher rigM•of•way use hereto <br /> �7� /���f�� � � � applied lor and lurther agrecs to remove came upon notice irom the <br /> qpproved lor Construc�n Date City and to replace puhlic property damaged thereby. <br /> L � <br /> �Q" ���� �%� � /�7�� <</ <br /> FINAL 14SPECT�ON ���e Oate <br /> Approved as CnnstruCted Signalure f Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> eve�e��+ F'UBLII:WORKSDEPARTMENT ip0 DAYS OF DATE PERM!T IS ISSUED AtJD 7NEREAFTER IS TO <br /> � I 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. 7HIS PERMIT MAY B6 <br /> 7 Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> JPhone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />