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Gate� r�m,c��'o��s PPi 8�O �y�8 <br /> qpplication For BIOq Ueo��• • ----/7� <br /> PUBLIC WORKS PERMIT PubTolelFeaFee s <br /> Le99 NOP�Fea PaiE S <br /> Balence D�e S 2� <br /> Print or Type Only ' <br /> ('� � � — -)�� ._ �� � :� 3 <br /> r\ � ��` /009-L�-c�OG.9�tl•c,/ EE.2E'T �ri:-'�'.�' CY ` <br /> ner Mailing Adtlress City Zip Phune <br /> ���7�.�� <br /> App ant Mailina Address City Zip Phone <br /> Describe Proposed Wark __�nyST.�UI-T� �✓ rF�'- <br /> — � <br /> PiolectAddresslilk� ! � ��J2S� " G%FLt/'C.C�L"�57� �IL�� _ �� <br /> Attach lour(4)copies of plans for propo�ed work- Dra•.v tu scale and note tne lollowins as applicable� � <br /> • Property Lines •-Cen'erfne ol sireet � <br /> s Outline and dimnnsions of all exi�tinq and • Intlicate N��Ih <br /> proposed structures on the lot • Sho�+any preposed grnding changes <br /> • Existing and prcposed utiiities • Show measurements � <br /> C:J NOT WRITE BELOW THIP,UNF � <br /> PERMIT CONDITIONS <br /> 7. All calls for inspection shall be made 74 hrs. in advance-phone 259-881 5. � <br /> 2. All work shall be performed in accordrmce with Ihis permit and current City of Everett Design and Consiruction <br /> Standerds and Specifications. <br /> 3. Call Location Underg�ound Service 4A hrs.beloie you dig.TOLL FREE NUMBER 1•800•42A-5555. � <br /> O <br /> � <br /> N <br /> O � <br /> a <br /> �/ ACKNOWLFDGEMENT OF CONDITIONS <br /> � � _ <br /> The�indersigned owner/zpalicant hereby ngrees to hold and cave harm� <br /> less the �::� ei Everett Irom any and all claims �or damages, custs, <br /> expenses, or �auses ol aclion that may arise because ol installation <br /> � �/� /��,_8G and maintenance ol ihe improvement or other righl-ol�way use hereto <br /> G%-�� �`� applied for and luriher agrees to remove same upon notice Irom the <br /> � Approved lur Cons�r tion Date City and to replace publi�property damayed ihereby. <br /> - !� � C <br /> _� � s> ;' -� �:, <br /> FINA INSPECTIO,V Date � ` � ����-� � I��� � �:�•— <br /> Approved as Co:�sVucted Si nature af Applicant Dale <br /> everelt FUDLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS FERMIT MUST BE STARTED WITHIN <br /> 1B0 DAYS CF DATE PEFMIT IS ISSUED AND THEREAFTER I� i0 <br /> � 3200 Cedar Streel BE DILIGENTLY FURSUED 70 COMPLETION. THIS PERA1fT MAY BE <br /> Everelt,WA 98201 C,4NCELlED BY TF.E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8875 PROJECT OVER oJ DA\'S DURATION. <br />