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Date�_�I 1'u�bcWorkaPermn♦ � ���+_ <br /> Applicalion For Bmo-D�ni�• _—__ <br /> PUBLIC WORKS PERMIT �°°To,e;Foe'°° s <br /> �ass nooi.Fea ra�a S <br /> Print or Type Only ea�a��ao�e s� <br /> � ��L,L4CE � Ma/LCtAC2��K.5oti1 8i16 ��_�oc�c.. �a -C�r 3s_3 -as�o <br /> Owner Mailing Address City Zip Phone <br /> �K�s�`C-Nv�..�F�. ��L l�Jcrw,oF-e - C.vr ��10 r �-S"..L-56 a 3 <br /> Applicant Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �'%���� L � � � F �� Ta-E« <br /> - Q � <br /> Pwject Address(il known) �w�'X-�- R�-�-�S U � �> � � <br /> Atlach four(4)copies of plans for proposed work- Draw lo scale and note the lollowing as applicable: � <br /> • Property l.ines • Centerline ol street /A <br /> • Outline and dim=����_^��I all enisting and • Indicate North V� <br /> proposed siructures on the lol • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Shuw measurements � <br /> DO NOT WRITE BELOW 7HI5 LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor inspection shall be made 24 hrs.In advance-phone 259•881Q � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standerds and Specilications. <br /> 3.Cali Location Underground Servic=48 hrs.before you dig.TOLL FREE NUMBER 7-800-424-5555. � <br /> �{, M � N�N��'N► 2�� oF ST2,n��/ iZ> Bcr 1��5TIZ � guTEY) O <br /> AC.LQO55 .nLL �4�C-7�S oF D�Siv2gE)� �CrZ�1-t L <br /> r <br /> M'M�. I M M C1���1 L� A F'j'�"12 P.0 t'10�I tJ C� ' I�ZI.-�5, � <br /> J � ,`)� LT �-F�1GE /�S PEIZ (>u $L�G \1/OiZKS If�Y��['0�25 O <br /> 1�� 2EcnON, a <br /> ACKNOWLEDG[MENT OF CONDITIO�JS <br /> ihe untleisinned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe City ot Everett Irom any and all claims lor damages, costs. <br /> eapenses, or causes of aclion Ihat may arise because ol installation <br /> /O .-. ' and main nance ol the im rovement or other righl-ol�way u5e herelo <br /> ap � d lor an lurt agree to �emove same upon notice Irom the <br /> Approved lor Cons ct p Date � y and to r la pu6lic pr (Serty dama9ed �hereby. <br /> �/l� / � C�' ,. <br /> FINAL INSPECTION Date � �� y 4� <br /> Approved as Consiructed ature ol ate <br /> �Ar� PUBLIC WORKSDEPAPiMENT WORK AUTHORIZ[D BY THIS P[RMIT MUST BE STARTED W�THIN <br /> 3200CeAarSireet 180 DAYS OF DATE FERMIT IS ISSUED AND THEREAFTER I� TO <br /> Everelt,WA98201 BE DILIGENiLV PURSUED TO COMPLETIOf.. THIS PERMIT MAY B[ <br /> Phona 259�8810 CANC[LLED 6Y TH[CITY UPON ANY STGPPAGE OF WOfiK ON THIS <br /> I PROJ[CT OVE-R 90 UA1'S DURATION. <br />