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Date3 �`�3 �}C� �„�����w�„�.��..,m�,. .--_ <br /> luea Den� . __— ___ <br /> Applicalion Foi <br /> PUBLIC WORh',S PERMIT r�oi�ow``er�� s -- <br /> ��R•Moi vee ra�d S _ <br /> eaw�c�oae S <br /> Print or Type Oniy <br /> �p,i� Sc O'7T <br /> pW�e� Madmc7 Address City Zip Phone <br /> qpplicant Mailing Addres Citq —�--- Z�n Phone �. <br /> � <br /> Descnbe Proposed Work — --- -- <br /> P�--�rZ A-?� Pi4��_',v/NCl L,pT_ <br /> ----- —- � q <br /> _ — — Ws <br /> c <br /> Pro�ect Address 1�1 krowN � " " '— —" ` ��/� � � ~ � <br /> APuh lom(4)copies o1 plans lor propesed work- D�aw to scale and note the lollowing as appficable: � <br /> • Properry Lines • Centerline of sireet � <br /> • Outllne and Cimensions ol all exis4nq and • Indicate North <br /> proposed structures cn the lot • Show:ny proposed grading changes <br /> • Ezisting and proposed utihties • Show measuremeNs � � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS j <br /> t.All calls for in.�pedion shall be mede 24 hrs.in advance•phcne 259•8810. � � <br /> 2.All work shall be Derformed in accordance with this permit and current City of Everett Design and Construction i <br /> Standards end Specifications. . <br /> 3.Call Location Underground Service 48 hrs.befae you Aig.TOLL FREE NUMBER 1•800-424•5555. � j <br /> t <br /> O � <br /> j�=tJ I�l7 " rf��TJS TU 13e f�`i�'�� � � <br /> h�o � ` <br /> --- Ly(��v r 1 <br /> � y I c� F} T1 r�16� O + <br /> — LrfNJScAl�,�,�, a ! <br /> �-7�. n�L� � Qz�-1y1�/A�iC' � <br /> �� //'/ I <br /> t��� AGKNOWLEDGEMENT OF CONDITIONS � <br /> � S//v The undersigned owner/apUlicant hereby agrees to hold and save harm- ! <br /> less the City ol Everett from any and all claims lor damages. cnst=, <br /> eapenses, or causes ol action Ihat may arise because of installation <br /> anA mainlenance ot the improvemenl or other righPohway use hereto <br /> applitd br and lurther agrees to remove same upon notice trom ihe <br /> Approved ter Consiruction �a�e C�ty and 1�replace public property damaged thereby. <br /> F�NAL INaPECTION Date <br /> Appwved as C,:nstructed Signature ol Applican! Date <br /> WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWOHKSDEPARTPAENT ��p pFYS OF DATE PEPMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarStreet BE DtLIGENTIY PURSUC-D TO COMPLETION. THIS PFRIdIT MAV 8E <br /> Everett WA 98207 CAN'. CLLED�Y iHE CI1Y UPON ANY STOPPA�E OF WORK ON THIS <br /> Phone:259�8810 PRf�JECT OVER 90 DAYS DURATION. <br />