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✓ <br /> J �j ,.�„ �w�,"�,.,m,. 8���'y <br /> Date-_ �'i. <br /> � I3�Aa DePi � -- __ ... _" ___ _ <br /> APPLrahen fni <br /> PUBLIC WORKS PERMIT r°''°`"'°"°"° <br /> ,��a���� s ----- <br /> �•�+ �nni [nrPn�nS __. - <br /> i�.�,,,,��o�� S y C <br /> Print or TyP� Only �-/+�'/� <br /> ,Fj�'/V��i y�<S/i�c Lc c_—y �( �'E �J��/ a�f'/'cZ'�'�'i c eF'r�-�_) <br /> Owner Mefhng ntltlress Gty 7ip Phone <br /> „ �=�c-�� y��� ��-.38� <br /> Applicant Maihng�dd�ess City Zip Phonc <br /> Desa�hc ProPased�"Jork //��T�LL �G'<�GIC' .SCC4L'—.�� <br /> W <br /> Prolect Atldiess UI knownl <br /> �T/�iFT �L/S�T_/o7C� � G��'� C�f'"' �O'C��`' � <br /> Atlach lour I41 copies ol pians lor proposed work- Draw lo swle and note Ihe lollowmg as apphcable: �� � <br /> • Properly Lmes • Centedine of street � <br /> • Ouilme and dimens�ons ol all ex�sting and � Show any p�oposed gradlny chang�� <br /> propo5e0 S�fuCWtes on Ihe 101 <br /> • Ex�shng and proposed uiihties • Shnw measuremenis M <br /> W <br /> pp NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be matle 24 hrs.in advance�phone 259•8810. <br /> 2.All work shall be pedormed in ecwrdance with lhis permit and current City ot Everett Design and Cor.struction <br /> Stendards and Specilicalions. <br /> 3.Call Location Underground Service 48 hrs.6elore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �/ �tc-��' �Sfll�iTiS�i�'!� Sc-�c�� - �c�1�'�cr'`� O <br /> I <br /> J�l.��.� ��/� G�/L�-E'S/��c� //��G'S'/ �'C- � <br /> ��,������s �„���� ��/�'� N <br /> O <br /> a <br /> pCKNOWLGD6LM-NT OF GONUITIONS <br /> ihe un�ers�gnetl owner/apphcant hereUy agrees Ic hold and save harm� <br /> -- less the Ciry of Everett irom any and all clalms lor damages, costs. <br /> �- expenses. or causes of action that may arise because of installation <br /> i--� - � <br /> � and mainlenance ol the improvement or oiher righbol�way use hereto <br /> �` applied lor and lurther agrees to remove same upon notice Irom Ihe <br /> A� ved lor C h �n ' Date �{�y and to replace pubhc proPerry damaged thereby. <br /> ��< <f-�s��f' � �- l- S 9 <br /> FINAL'INSPECTION �a�e Date <br /> Approved as Consirutted Signa ie ol Apph t <br /> WORK AUTHORIZ D 9V TNIS P[fiM1T MUST BE STARTED WITHI�I <br /> p�p��.�� PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200CedarStrecl BE DII.IG[NTLY PURSUED TO COMFLETION. THIS PERMI7 MAY BE <br /> EverntL WA P9201 CANCELLED �Y THE CITV UFON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJF'CT OV[R 30 DAYS DUR�TION. <br />