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Date�'��-� „�,,,,,.,,�,�.��,m,�. ------ <br /> �nea oern • � <br /> Appiication Fo� <br /> PUBLlC WORlCS PERMIT �uero�ren��� $_ <br /> Les��no�fne Pe�f. S <br /> eeir�cro�o S <br /> Print or Type Only <br /> t� � � � ;. Nd 6 I)rn���� d/2 �IJ7 �l8zo� Z �9-c��z� <br /> - Mrding Address Cdy lip Phone <br /> Owner <br /> — Ap�F !� la����z <br /> Mading Address Cdy Zit� Phone <br /> DeScribe PropoSed WOrk ' <br /> L�-nr �zF =s�'-r«- SYsr� — <br /> - W <br /> z .� - �. <br /> Prolect Address(il known) <br /> � <br /> Atlach four(41 �op�es of Plans lor pro0osed wo�k� Diaw to scale and note Ihe lollowing as applicable: � <br /> • property Lines • Cenledine of street <br /> • Outline and dimensions of all existing and • Indicate Noith <br /> proposeA siructures on the 1ot • Show any proposed giading changes <br /> • Evistinp and proposed utililies • Show measurements M <br /> W <br /> DV NOT WRITE BELOW THIS LINE O <br /> PEAMIT CONDITIONS � <br /> i. All calls tor iospeclion shall b^made 24 hrs. in advance� phone 259•s81 5. <br /> 2 All H ork shall be performed in acwrdance with Ihis permit and current City ot Everett Dr,sign antl Consiruclion <br /> Sta�:dards antl Speciticalions. � <br /> 3 Cal Location UnAeiground Service 4B hrs. belore you dig.TOLL FREE NUMBER 1•800•4L4•6555. <br /> O <br /> / � <br /> ��� �� ` /�I (,� � I� � <br /> � ��� �l� /I/ = � <br /> � � r��� � ,�-�� _- o. <br /> ACKNOWLEDGEMENI OF CONDITIONS <br /> The unAers�gneo owner/applicant hereby ac�rees to hold and save harm- <br /> -- --� less thr. Cdy ot Everett Irom any and all claims for dama�es. cosls, <br /> expenses, or CauSe� Ot aciion ihat may arise becau5e ol installation <br /> and maintenance ol ihe improvemenl or other right-of-way use heretc <br /> applied for and lurlher agrees to �emove same upon noliw ��om the <br /> Npproved lor Conslructlon �a�e Ci1y and to replace public property damaged thereby. <br /> FlNAL INSPECTION Date patc <br /> Hpproved as Consiructed <br /> SI�naWre ol ApplicaN <br /> VJORK AUTHORIZE� BY THIS PERMIT MUST BE STARTLD WI <br /> �vrrrit PUBUC WORKSL"cPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32U0 Cedar SVeet I BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAv BE <br /> FvurctL WA 98201 CANCELLED BY THE GTY UPON ANY 6TOPP�RG OF VJORK ON THIS <br /> ` Phone. 259�8875 PROJECT OVER 90 DAYS DURATION. <br />