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�-�._,fM ---- . .. <br /> ��_._ _ . ._.. _ _.. _ .. - -: ... <br /> — - -- --_.._. __ .. _.__.._ . _. _ <br /> Date v„oncworwnve�mna ��—/�� <br /> Applicafca For o�ee oeo�.• <br /> PUBLIC WORKS PERMIT P����cWorbiee <br /> iolxlFee S <br /> Less ApP�Fxe Peid S <br /> � O <br /> Print or Type Only saiance o�e S G�� <br /> �. .Sko ��� P o Qox �3 ��.-�t�- 9�z��-� �s�y3s� <br /> � Owner Mailing Atltlress City Zip Phone <br /> A_ ��c�7o.�� P o Box �73 ��e..� �- � e�to� ��� �.�.r� <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe P�oposed Work ���i /� /1�/G'� —/CC / �e�7' Z�/ �� � <br /> _ 22- 3� �Pu�.kei-' <br /> Project Address(ii known) � 2-3 � KUGI�eN�Y � �I�1 VY� 17 i� ,.lf /3- �"� � <br /> �—_1 � <br /> Attach four;4)copies of plans lor proposed work- Draw to scale and note Ihe lollowing as applicable�. � <br /> • Property Lines • Cente�line ol sireet � <br /> • Outline and dimensions of all esisting and • Indir,ate Norih <br /> proposed siructures on ihe lot • Show any proposnd grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tnr inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be Uei lormed in accordance wi�h this permit and current City ot Everetl Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Ur�derground Service 4B hr,. belore you dig.TOLL FREE NUMBER 1•$00•42�{•5555. � <br /> � ��«y T �E ,���F� �E� �,y 5=�,��A.�� O <br /> �`,�o,..� <br /> -�� CONTIrY>'!'T o� O,C Ar��'�icA+✓T /S if'rG�ui��D %� SET ��/� <br /> /Ji� �9 /"�7EET2'G �t/iT.s' TiyE� f������ �yo,{>,C S Y/ <br /> 1ivSr_,l"�in.f' fi'T TisiF Joa' Si'E y�'?�oi2 T'o O <br /> SC/fE�7�-G:2,� ��y�i,�.� T ttJo,c:� Ci'�J G��flv�ir/l. DETf�icS � <br /> ACK��OWLEDGEMENT OF CONOITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm- <br /> less ihe City oi Everetl from any antl all claims for damages. costs. <br /> � " expenses, or causes of action that may arise because ot installation <br /> ` �s� �L�� �T ��t4G and maintenance of the improvement or other right-of��vay use hereto <br /> applied for and furlher ac�rees to remove same upon notice Irom the <br /> Approve6lor Consiruction a�e City and lo replace public property damaged.thereby. <br /> �i���� Sl /s'- •� �= i;z.� ��; <br /> , <br /> 'FINAL IVSPFCTION Date � �"G-% � _- � �j���-��- /�� <br /> Approved as Constructed Signature of Applicant Dale <br /> everelt PUBLIC WORKS DEPARTMENT WOfiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3e"00 Cedar Slreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 9A201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />