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� � <br /> ' i�'��5, t3` iZ-�3-2�•4 ;�. <br /> ��D ,5,�• � 3 Ca 3 <br /> Dale Pubi¢Wode Pormi <br /> eieo ocm • <br /> qpplicalion For ` <br /> PUBLIC WORKS PERMIT PU�Totrlfee`eB = <br /> �ess ApPI Fee ParJ $ <br /> Ba�ance0ue � ��I <br /> Print or Type Only <br /> (��ll�� ��'3VIC'�/��' • ��l`-��� l�" /�I.p �L.�'1":�'��1��� '���-�/�7 <br /> Owner Mainng aaoress .,��y Zip Phone <br /> r�Prp�i y�� Mailin9ACdress Cily Z�o Phone <br /> Describe Proposed Woik ��—" <br /> W <br /> Pro�ect Address(if known) _ 93OC-c' — 1 5T A�/L S� � <br /> Attach four(4)r,opies of plans ior proposed work- Draw lo scale and nole�he lollowing as applicable: � <br /> • Property Lines • Centerline ot slreet � <br /> • Outline and dimensions of all existing and • Indicate Nor�h <br /> proposed slructures on the lot • Show any proposed graUinc� changes <br /> • Exi�ting and pruposed utililies • Show measurements � <br /> � �DO NOT WR�TE BELOW THIS LINE O <br /> PERMIT CONDITIUNS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be FeAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards end Specifications. <br /> 3.Call lccation ilnderground Service 48 hrs.before yuu dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACI<NOWLEDGEMEt!T OF CONDITIONS <br /> �,��� <br /> 7_T The undersiyneti owner/applicant "y agrees to hold and save harm� <br /> �. less Oie City ol Evere�t Irom am .� all claims for dama9es, cosls, <br /> ��'�� expenses, or causes of action t � ry arise because of inslallation <br /> �� ����_ .7 �3 p_� and maintenance of ihe improv �. or other righPohway use herelo <br /> applied lor and luriher agrees + � �� move ;ame upon notice Irom Ihe <br /> Approved nstr cf n �&����� _ Date CiIY and lo rePlace Public ProPei.; ..amageA thereUy. <br /> i <br /> ' n I <br /> � � �i / i � 1 <br /> Da�e / <br /> L� % � // <br /> -.�. . —£�� � /�7�� ..c. 1 `��7 <br /> FINA lNSPECTION Date <br /> Approved.is Conslructed Signa ure of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ev:,rett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPIETION.TIiIS PERMIT MAY B[ <br /> Everett,WA 9&201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNI� <br /> Phone:259•8810 FROJECT OVER 90 DAYS DURATION. <br />