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I <br /> � <br /> I <br /> I <br /> II <br /> Date /" ��t � �� Publ�cN'mksPm��msil�• � �J <br /> . ' BIOP �ePl.•_y U( �J �/� <br /> Application For T 1 I <br /> PUBLIC WORI�S PERM ��' °°°'�°W°«=`°° -- <br /> To�,��e� s <br /> Le:s nnoi Fee Pa�a 5 <br /> Batrnce0ue $ <br /> Print or Type Only <br /> �n i. i i�q./�AJ S /i/O f- �J~1�2 SE % ��� 3 Y7- �30 6 <br /> Owner Mailing Address Cily Zip Phone <br /> �, o � 72-�.�-C �-��'-� �'Aef• 3a ���i.rr � SLns� 3.3Y- a �'�6 <br /> Applicant F4�nihng Address City Zip Phone <br /> Describe Proposed Work ��-�-� L �G ,J'�G� �/7-s-� ��se1� <br /> 0 <br /> � <br /> Project Address lif known) � <br /> Hltach lour(4)copies ol plans for Uroposed work- Draw to scale and note ihe IolloNing as applicable: � . <br /> • Property Lines • Centcrline of sireet /A <br /> • Outline and dimensions ol all existing and • InJicel�! North V� <br /> proposed siructures on ihe lo� • Show any proposed c�radinc�changes <br /> • Existing and proposed u�ililies • Show measuremeNs � <br /> DO NOf WRITE BELOW THIS LI��E � <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall ba madF 24 hrs.in advance-phone 259•S$10. � ,I <br /> 2.All work shall be performed in accordanca with this permit and current City ot Everett Design and Const«iction <br /> Standards and Specilications. <br /> 3.Call Locatioii Underpround Service 48 hrs.before you dig.TOLL FREE NUMBER 1-8�•424•5555. � <br /> O <br /> N O t�8 l_i C, I.J U iZ K.S r`�C=f�.M �T I�'--C Qu i�E1� � .••-- <br /> P�..Jt-- nn L�- � <br /> �}- /i� !�j0 O <br /> a <br /> ACKNOWLf_OGEMENT Of CONDITIONS <br /> The undersigned owner/apPlicant hereby agrees to hold and save harm- <br /> Iess lhe Gty ol Everett Irom any and all claims for damages. wsts. <br /> ezpenses, or causes of action that may arise because ol installation <br /> and maintenance ol lhe improvement or other righPof-way use he�elo <br /> applied br and further agrees to remove same upon notice Irom the <br /> Approved for Consiruction Date ���y and to replace public p�operty damaged Ihereby. <br /> FINAL INSPECTION Da�e <br /> Approved as Censiructed Signa;ure ot Applicant Dalc <br /> WORK AUTHORIZED BY THIS PFFMIT �1UST BE STARTED WITHIN <br /> everett PUPLICWORKSDEPARTMENT 1P0 DAYS OF DATE PERMIT IS ISSUEf) AND THEREAFT[R IS TO <br /> � 3200 Cedar Sireet BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br /> Everett,W�98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�9810 PROJECT OVER 90 DAYS DURATION. <br />