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2� ��� PuIL¢YlOrk6 Va�mi�� ����� <br /> �late/%�� F31�9 UcPI.• .__.—_ <br /> Application For <br /> PUBUC WORKS PERMIT °°°��°w°��°°�° s — <br /> in:tl FPC <br /> less Rn01 Fe«Pac1 $� <br /> ua�a��e o�.. S .-�Cz�-� <br /> Print or Type Only — <br /> /J/��.L/�S' ��So�✓ 3L.3a�.-�`c�O P�c+/✓T- Ev P�'P 'l T- J�3�2.�3 — .ZS.2- 8033 <br /> Owner Mailing Address Ctly Lp Phone <br /> i / � <br /> ���� — <br /> Appllcant Mailing Address G�y '-iP Phone <br /> Describe Proposed Work -x�•ST�L L �iP/d Q Y��l� � <br /> W <br /> Proled Address�if knowN � �'�J 2�'����� � � <br /> i <br /> Atlach four(4)copies of plans for proposed work� Draw to scale and note Ihe lollowing as applicable: � <br /> � Properry Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed struclures on the lot • Show any proposed grading changes <br /> • Eaisling and proposeA utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All�alls�or inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current Ciry of EvereU Design and Construction <br /> � StandardsandSpecifications. <br /> j 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> f � �. <br /> `� �/�ec��-,zf !c�-��� .ILG /LFi�k�Le�l:C� � -Cns.�cceZ:��9 O <br /> � 0 <br /> q�A czcz��-J(t..L�t` .C�� �Q lc�.� �/.,✓ _¢n'I�c, c� ��ci />cacCw2c} - <br /> �7 i � <br /> � �J�Zcc.v e�f ./2.2��t c:'.;,Z=' .�^('�,� /�.,tc�,nx���� �,'� /2CC.a/ �v+�� �/��'cll <br /> � ° ° 6� � <br /> OB/28/89 1:OSr'Pf OOORH7b12 O <br /> � a <br /> auoo�s�io <br /> uF.L'W'J m20.U0 <br /> L'H�Cf; 5�0.0� <br /> � ACKNOWLEDGEM[NT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> O,C f�,�/-' LL�ti�"��S less the City of Everett Irom any and all claims lor damages. costs. <br /> // � eapenses, or causes of action �hat may arise because of installation <br /> �{�� ��/�/✓ /�/ /, and mainlenance of ihe improvemenl or olher right-of-way use hereto <br /> / / • �L"C'�' ��G L applied lor and lurther agrees to remove same upon notice trom ihe <br /> Approved for Constr ion _ Date Cily and to replace pubfic property dama�ed thereby. <br /> �'� ' •a-�-�'0 ��// 7 /�'� �/ / i/,2�3�?//� <br /> FINAL INSPECTION Date � "" � ���"��` "'""-'`� Z ` <br /> Approved as Constructed SignaWre ol Apphcant Date <br /> WORK AU7HORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1B0 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M,AY BE <br /> Everet6 WA 99201 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />