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�ate_��,�.�7 fW�uWo�c..Vmmit• �� /•.� <br /> � ��� <br /> Bl1u�Dcn� • <br /> ��nn��calion For <br /> PUBLIC WORKS PERMIT '�ubTola�FarF°' S - <br /> ��tis Ap01.Fea YaIJ ���-- <br /> �aianco Oun S ��^ <br /> Print or Type Only <br /> A. c� tNuc�. � ,1.. i.no 3 1.�10 , nc,��t. ��P���S�- 9��a3 a5d- y7a3 <br /> Owner Maihng Address Cily Zip Phnne <br /> �� �DYlffYui T r /� — --. <br /> Applitani Mailing Address Cily Zip Phone <br /> Describe Proposed Nbrk �'I����._L1Y/N� /!a f�� <br /> W <br /> Project AtlA�ess(if known) _ G�6�'� — ��Fv C � � CvT m' 3 La <br /> Oi- ,c�ul- S r <br /> Attach lo��r p7)copies ol plans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed sirudures on ihe lot • Show any proposed grading chanqes <br /> • Existing and propesed utilities • Show measuremenis � <br /> DO NOT WRITE 6EL0'NTHIS LWE O <br /> PER�IIT CONDITIONS <br /> i. All calls for inspection shall be inade 24 hrs. in advance- phrne 259•88�S. � <br /> 2. All work shall be pe�formed in accordance with Ihis permit and current City of Everett Design and Constructicn <br /> Standards and Speciticalions. <br /> 3. Call Location Undergruund Service 49 hrs. before you dig.TOLL FREE NUMBER 1•800•424•55$5. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIOIJS <br /> � �y�i� The undcisi�ned owner/applicant hereby agrees to hold and save harm- <br /> les= the Cily ot Everett from any and all claims lo� damages, costs, <br /> ,•�, eapenses, or causes of action Ihat may arfse because ot installatior. <br /> C, `� . /) / ,7 J and maintenance of ihr improvement or othe� ric�hhol�way use hereto <br /> �� ��� applicd lor and lurlher agrees lo remove same upon notice lrom Ihe <br /> Approved lor Constructio Date Cily and to replace publi roperty damaged there6y. <br /> �� �� ��— ,� �'-d� I� 3-L3-�3-� <br /> FINAt,.7 F CTION Date � <br /> ApGroved as Constructed S nature of Applic nt Date <br /> — WORK AUTHORIZED BY THIS FERMIT MUST BE STARTED WITHIN <br /> everetl PUBLIC WORKS DEPARTMENT �g0 DAYS OF DATC PERMIT IS ISSUEQ AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evr.rei�,WA 9E201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON TFIIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />