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�8}@5..�—✓ i a�inim wm�s vn� i• l7 7�`��`� <br /> Applicalien For ��M9 DeO� • ���1���—� <br /> 1 <br /> PUBLIC WORKS PERMIT °°°�°�°°�15FCe <br /> ,a�a���� S— <br /> Lrvss Appl Fee PaiE S <br /> � <br /> � <br /> palanCCOur $ �—�-' � _ <br /> Print or Type Only — <br /> �'►��.nMl? ) or�n�( ��.� �i��� S�- S'�c� �11�" �i� _S �1� '. <br /> Owner Mailinc�Adtlress City Zip Phone <br /> ��-, r� 1 <br /> Applicant Mailing Address City 2ip Phone <br /> !�Descnbe Proposed Work L <br /> W <br /> ProlectAddressUlknown) �`': 7�'C� — � -)y�'�-: •S�. � <br /> Attach four 141 copies ol plans lor proposr,d work- Draw to scale and note�he following as apPlicable: � <br /> • Property Lines • Genterllne ol sireet � <br /> • OuUine and dimensions ol all existing and • Intlicate North <br /> proposed siructures on Ihe Io1 • Show any proposetl grading changes <br /> • Eristing and proposed Wi6ties • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance with this pennit and current City ol Everett Design and Construction <br /> Slandards and Specitications. <br /> 3.Call location Underground Service 48 hrs.before you dig.TOLI FHEE NUMBER 1-800-424•5555. � <br /> !/ .i . . , • /� / O <br /> 7. 2'l�Z:j.•ll �Z �C«, ��..�:..t �.�C . /��i�rY�.{:</ Cc� �'�vif t.,�. r t � <br /> . �' <br /> ��:,�.G�v l�-i�c���� . • �;, ;� �1�-z. .�::J , .•i.,". h ,... <br /> ��, <_,� z�,,. -ri,������,� , ��� � <br /> � <br /> 0 <br /> a � <br /> ACKNOWLEDGEAfENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City ol Everett Irom any and all claims for damages, costs, <br /> � enpenses, or causes ol action Ihat may arise because of installation <br /> �•//� and mainlenance ol the Improvement or olher right-obway use herelo <br /> [�>>��� �/� '�/J�—� applied lor and lurther ac�rees to remove same upon notice hom Ihe <br /> Approve �'br � onstrucli n ate City and to replace public property damaged thereby. <br /> G � <br /> � ..,- s/��� ., � / -c <br /> FIN L INSPEC� � � � Date �� � `� '� ( �� � <br /> Approved as Constructed Signature ol Applicant D�ale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everr[t PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIG[N7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA9B201 CANCELLED BY�HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OV[R 90 DAYS DURATION. <br />