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�` 7 <br /> Date ����,���ti�,,,�����,m,� , 87'c''9S� <br /> AUphr.ohon f`or �m�� u�i,i . �� <br /> ���•.-� <br /> PUBLIC WORKS PERMIT ���',;�,�FaoF�o � <br /> LnaaAppl.ieePai� $ <br /> Print or Type Only ���•������ 5 �o.� <br /> L�,� s LiV r�'��/°%'��'�,S c� � '7 G-� �e��w a i e-,ti Cv 9�'�b.3 .�s' 3 y �� S�.d <br /> Owner Maihng Address �i� <br /> Y Z�P Phone <br /> ,C�1 G`�7 �Cv�J �/S � S 6��i17V'l�� � tN�2I � �'-tH L�fJ 79,iO� f � S �- y �� <br /> Applicant � Madmg Address �i� � <br /> Y ZiP Phone <br /> Describe Proposed Work .,�e�D v_ t /'t�d P �-✓ �'� v �e 9 <br /> A.vt� C'o,�Js.-.e ic7- A .r�.rii�� i=Ain,c c�/%us <br /> ; - <br /> Project Adtlress�il known) _n y d p U /J O [. �/ �/ �c1� Y•��_ . � <br /> Atlach lour(4)copies of plans tor proposed work� Draw to scale and note the lollowinp as applicabla � <br /> • Property Lines • Centerline ol street � <br /> • Oulline and dimensions ol all existing and • Indicate Norih <br /> propesed struclurea on Ihe lot • Show any pioposed grading changes <br /> • Eaisting and proposed utilities • Show measuremenis � <br /> DO NOT WHITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls fur inspection shall be made 24 hrs. in advance- pl:�ne 259•881 5. � <br /> 2. All work shall be performed in accordance with�his permit and current City of [verett Design and Consiruction <br /> Standards and Specitications. <br /> 3. Call Location Underground Servico 48 hrs. belo;e you dig.TOLL F.qEE NUMBER 1•800•424-5555. � <br /> /iGNT-Li.v� .�i..L7F- To.� l�cT.Fr�/-�SPou,—s To L�P[/�;/�ECG.r, O <br /> / <br /> � <br /> � <br /> � <br /> a <br /> ��f ACKNOWL[DG[MCNT OF CONDITIONS <br /> ���4 The undersigned owner/applir.ant here5y agrees to hold and save harm- <br /> less lhe City of Everetl trorr any and all claims lor damages, costs, <br /> ezpenses, or causes ol action that may arise because ol instal�ation <br /> �_� ���j�' �ry� � �J�7 and maintenance ot the improvement or other right�ol�way use hereto <br /> applied for and lurther agrees to remove same upon notice from ihe <br /> Ac�nroveA br Conshu �on ' �e�e City and to replace public property damaged ihereby. <br /> . � y� <br /> ��� " �-�i�G . <br /> ��;; �-, <br /> FINAL INSPECTION Date �`-r���-�L'zC,l %j , l��I�i .� <br /> Approved as ConsUuctetl Signature ol Applicant y '� Date <br /> rverei� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Gedar Sheet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> Everett.WA 98201 BE DILIGENTLV PURSUED TO COMPLETIOIJ. THIS PERMIT MAY BE <br /> Phone: 255�881 5 CANCELLED BY TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 pqVS DURATION. <br />