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Data�A � �S <br /> PubLc Works Permit• <br /> Application For emo.ono�.• � Q _ <br /> PUBLIC WORKS PERMIT PuoTotelFeaFoe s — <br /> Less Aon�Fex Peia S <br /> Print or Type Only Be�ance Doe s ��-� <br /> / 7b��S <br /> CN,'L�Zc.l C o.v -r2 / 9Zlp 4'�r,�f �--�. !� �c�? �Zo 3 ss--�yiy <br /> Owner Maiiing Address Cily Zip Phnne <br /> ��s�,� /� �,pc��� <br /> Applicant Mailing Addrnss Gly Zlp Phnne <br /> Describe Proposed Work �-x`.�/�657'.�-�. �J i� �[s� <br /> Project Address(ii known) ��.=''� - �i7 0� L��_ .S. E ,!C7i /J � <br /> Atlach lour(4)copies ol plans for prr,posed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol slreet � <br /> • Outline and dimensionu of all ezisting and • Indicate Nr.th <br /> pro.r.osed structures or ihe lot • Show any picpqsetl nrading ch.�nges <br /> • Existing and proposed utilities • Shew mea�wements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PFRMIT CONDIT�ONS <br /> 1. All calls for inspection shall be made 24 hrs. in ativance•phone 259•8$�5. � <br /> 2. All work she!I be periormed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards ar,d Spec�fications. <br /> 3. Call Lor.ation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> f� /�e�JL �.� Ti�LQ.vi� MorEF,a C `i�p��,- :;�� O <br /> S, Tit/STa/� �.ei6�Fc�a/ �S'T.c F�'i <br /> Co,c���;�I- .Q: H . <br /> �F tiFc ��ss,a,e , <br /> /o , �i'G i�E' S�af'F n,�� s V♦ <br /> i:F So tiS �/�i7' � <br /> T /n7l?olr Ao�� CF.�✓T LaTS �'�7"ii <br /> �nd/iV-GU�frc_� �'c��Vn/� � <br /> ACK�OWLEOGEMENi t)FCONDITIONS <br /> The undeisic�ned o�vner/aUUlicant hereby agrees to hold and save harm- <br /> less the City ol Everett irom any and all claims lor tlamages, cosis, <br /> f� / eapenses, or causes ol action that may arise because of installation <br /> ��/�-+?c��� G� 4. - �s- a�id maintenance ol Ihe improvement or other righ4oFway use hereto <br /> � applied br and further agrees to remove same upon notice Irom the <br /> Approved lor C t tion Date Ciry to replace public property damagetl ihercby. <br /> ��/�Si i <br /> FINAL INSPECTION � Date �I '�� <br /> Approved as ConsVucted � Sign ture of Ap c nt Date <br /> everett PUBLIC WORK DEPAFTNIENT WOFK AUTH ED 0 HIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PE9MIT IS ISSUED PND THEREAFTER IS TO <br /> Everett,WA 9II201 8[ DILIG[NTL�' PURSUFD TO COIviPLETION. THIS PERAIIT MAY BE <br /> Phone:259•8815 CANCEL LEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJLi.T OVEC 90 DAYS DI�RATION. <br />