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�` /�-" �r7s� <br /> Date� L� �� P„„���v��o��•�„n,�. �'�= <br /> �PP��calion For eiaa oon� •�� <br /> PUBLIC WORKS PERMIT °°^���W���,F�� <br /> ,��.���e s <br /> i.�,s�anN r�ara�a S <br /> O <br /> PriMorTypeOnly �„�,"��o,� s�_05� <br /> y�l�C���x� r� ��30 ,���r ,�e� .��� N�P�f�`- <br /> w0 ner �dailing Address City Zip Phone <br /> be n n� � �o,�.s i— i t��7 � Sa�,�Do I,.�.,,�.�1 Gf /�� (�?�%�Y�l'1 �1�,�U-� <br /> Apphcanl Maihng Address City Zip Phone <br /> p ��^ J'f����,� ���/ J I �1��! •I� �L.�.-L�/� � �L..LJ <br /> Describe Pro osed Work ` <br /> - W <br /> Prolect Address(il known) - ` � <br /> Attach tour(4)copies ol plans lor proposed work- Draw lo scale and note the Wllowing as applicable: � <br /> • Property Lines • Centerline ol sireel � <br /> • Outline and dimensions oi all existing and • Indicale Norih <br /> proposed s�ructurr,s on the lot • Show any proposed prading changes <br /> • Existing and pref'osed ulilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspectior,shall be matle 24 hrs. in advance- phone 259•88�$. � <br /> 2. All work shall be perlormed in accordance with Ihis permit and current Ciry of Everett Design and Construction <br /> EtanAards and SRecilications. <br /> 3. Cali Locztion Undergruund Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> /. C7l�J��O.E.E OitJ SiTE TO f�f- I�YJ.VE �E'� Ar'r�.c Ul�a�� /�L A,.� O <br /> u�/TE.O /2 -Z-$7, ��TTAC/��U� <br /> S LA.r/OSeAPiN!f .A�f/.0 /�i?�?.ti�f/G Ac'R/��JC-EM.E�c/1 �D �_F 1�G,•/f' � <br /> PE.e /�lH�/ /-,�v,,�FOVEO b�'-' fi!>��/✓i4/i lIFI�%. I��G��AJ � <br /> Arl�Jc.y�v. � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City ol Everetl Irom any and all claims lor dameges, costs, <br /> -- - ---'—> - eapenses, or causes of action that may arise because of instaliation <br /> x j� _�'-�" ��� / j.%� and maiNenance ot ihe improvement or other right-ot-way use hereto <br /> i _ � J" <br /> Approved 1 C nslructi0•� // - ' Date applied lor and lurther agrees to remove same upon notice from the <br /> . / City and to replace�ub\c property damaged ihereby. <br /> �i� �1�.yy ,/�///, '/�� 1 ;/�� G <br /> FINA Dale l �(lh - `.. -�{�'-�^� �C'-C ��/O � <br /> Appr ed as Construcled �igna�ure of Applicant Date <br /> PUBLIC WORKS DEPAFTMENT WORK AUTHORIZED BY THIS PERM1IIT MUST BE STARTED WITH�N <br /> eV� 3200 Cedar Stree� 180 DAVS Of DATE PERMIT IS ISSUED AND THERE-AF7ER la TO <br /> Everett,WA 98201 BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITV UPON ANY STOPPAG[OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />