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Date q//d/�.'�' �„����,vo�.sP<<�„� �'� ,3,3 - — — _ <br /> � � Application For amp oro� � - <br /> ���� - <br /> PUBLIC WORKS PERMIT PubLr.RbrhSFee r{— <br /> �(!CT AUG 0 4 1991 T�"�`°" s�i�-- <br /> TOti,'.,� ING Lessnm+iFeePT�� S �c�_ <br /> �o�� s 2�3G — <br /> Print or Type ONy <br /> 7�n�o-7S{'` vn N � �'l1Gtrys ✓���� : roz > U (os�7� q� <br /> o„� lYl�,� lP^.�-8,���i4��- � 98.-c�3 � „7..� �-T�',-.T� <br /> � Mailing Atldr ss City 7_ip Phone <br /> )qM-R� <br /> Applir.ant Mailing Address City 2ip Phone <br /> DescribeProposedwork ,CVPciJ � �U�� ��AQr�MP� !' Dui�A��hci <br /> W <br /> Proied Address lif knownl �828— �Ai.tJFL-.P J�,P _ � <br /> Attach lour(4) cop�es of plans lor propOsed work- Draw to scale antl note Ihe following as applicable: � <br /> • Property Lmes • Centedine of sireet � <br /> • Outline and dimension�of all ezisting antl • Indiwte North <br /> propOsetl SiruCtures on the lot • Show any proposed grading Change5 <br /> • Ezisting and proposed utillties • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cails for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shail be peAormed in accordance with lhis permit and current City of Everetl Design and Consiruction <br /> Standards and Specilications. <br /> 3.Cal�Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � �'`"� a��r��L Jo l�r�'S n'�r�� / -23 �`�v � <br /> / <br /> I"' <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett trom any and all claims lor damages, cos(s, <br /> �r- — ezpenses. or causes ol action that may arise 6ecause ol inslallation <br /> � � . <br /> antl maintenance ol �he improvemen� or other righ�-ol�way use heretn <br /> applied for and lurthei agrees to remove same upon notice I�om the <br /> Appr ed lor Ca6stru � Date Ciry and to replace pubhc properry damaged thereby. <br /> /07 i7— si ' <br /> FINA s cn N Date ��-�-�, 7�� 7�����vJ L��.��4/ <br /> Approved as ConStruc�ed Signature ol pplicant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLICWORKSOEPARTMENT 1g0 DAYS OF DA-E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGEN7LY PURSUED TO COMPLETION. 7HIS PERMIT MAY OE <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />