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Date'�� j!'—OJ ���J I .;>J � INW ���eonwo.ksv��mn. =�!-.i3� <br /> EIiOp DeO�.• <br /> ApPlicalion For �z_ - �i ��� <br /> PUBLIC WORKS PERMIT °°°°°`°°�'°`°° --_ <br /> ro„�F�P s_. <br /> lrssann� ferPa�n S ` — <br /> B.tCin.�.Dur $ ��-+ss <br /> Print o' Type Onl;� <br /> 7ylK 9 Sl�.dJ �S�F�l /C�.i 07 -,J'=`�.n.f S,E t��'%. h�� �9�Cvr' ,3.��5-579� ' <br /> Ownei Ma1!ing Address Cdy Zip Phone <br /> !t ii�G iAiy� ,{n/�c,ni3 Gs:' - Sv.9� _ <br /> Applicant htailing AddresS City Zip PhOne <br /> DescriUe ProPosed Work ��STi�L! C(-��Bf l�Ui7fY: �lii0 eSiQ.:l���Y/(' <br /> n i c�i, �. �-s�i - Fo�1 Siln,tr�'lfJi /? 2- �A-�'�5' I <br /> �7Lf ti c� 7`�iE C'/'f�'�i I <br /> Prolect Address Id knownl /n�n 7 — -��-� '4f�� `'C � I <br /> Attach�our 14)copies ol plans lo�Proposr.d worh� Draw to sr.ale and note the following as apPlica6le�. � <br /> • Property Lines • Cenlerline ol 5treet I II <br /> • Omline and dimensions ol all eaisting and • Intlicate North � I <br /> proposetl siructures on Ihe lot • Show any proposed gradmc�changes <br /> • Exisimg and pronosea utlldies • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE � I <br /> PERMITCOND1710NS O � <br /> 1.All calls br inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with Ihis permil and current City of Everett Design and Consiruclion <br /> Standards and Specilicaliuns. <br /> 3.Call Location Underground Service 48 hrs.b�fore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 5� Ll/L�k',e jo f�� 1)nNE f�FiZ !9P/'�ec%c1] /�l�'�S� � <br /> /�9i�D ��.��� -b�'9 �Cc.f'� .q17.91/fr0� <br /> � <br /> N <br /> a <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The und^rsigned owner/applicani hereby agrees lo hold and save harm- <br /> — less the City of Everetl Irom any and all claims for damages, costs. <br /> expenses. or causes of action that may arise because of installation <br /> ..—�i_.����.�, ��C�jY and maintenance of the improvement or other rightrof�way use hereto <br /> L <br /> �" J applied lor and lurthrr ac�rees to remove samc upon notice Irom ihe <br /> Approved igonstiuclion � Date City �d to replace public property damaged �hereby. <br /> - �� ,f� �//� <br /> � �� � , <br /> FI L I S ECT . ` . Date "� � "��f�� <br /> Approved as Constructed ignature of pp il can� Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��,i�e�� PUBLICWORKSDEPARTMENT �gp DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CedarSireet BE DILIGENILY PURSUED TO COMPLETION. THIS PERh11T M11AY BF <br /> Evereu.WA 9A201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />