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Date�� �x J�� �•„���,�w�,�.N�,m��. _ <br /> Applica�.on Foi <br /> A��a Den��� _— <br /> PUBLIC WORKS PERN9IT P°°To,„Fa�°°° : — <br /> Less Ant�� �ae PaiU S_ <br /> Bniancr0ue S <br /> Print or Type Only <br /> ` )E��� <br /> Owner MallinyAtldress Cdy Lp Phone <br /> Applicant Ma7iig Address C�ty Zip Phone <br /> Destribe Proposed Work _____LE^YV.t 11-F __,�,jl.'�l ���VI l! 1 L( 1 <br /> --- W <br /> .�, - I- <br /> Prolect AdCress 1if known) <br /> Attech four�4)copies ol Dlans for proposed work• Oraw to scale and note thc lolbwing as applicable: � <br /> • Property Lines • Centerline ol stree� � <br /> • Outline antl dimensions ol all eeisting and • Indicatc Norih <br /> propose J structun!s on ihe loi • Show any proposed grading changes <br /> • Existing and proposeA utililies • Show measuremenls � <br /> DO NOS JJRITe BELOW THIS LINE O <br /> PERMIT CONDIi101J5 <br /> t.All cali� for inepectlon shall be made 24 hrs.in aC,ance-phone 259•8810 � <br /> 2.All work shell be�ertormed in accordance with ihis permit and current City of Everett Design and Consiruction <br /> Standards and Sp�ncilicetions. <br /> 3.Call Location Und�3rground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5$55. � <br /> �� �'��i� � O <br /> ,� <br /> - 9-�2 -88 I-- <br /> � <br /> Q <br /> a <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> The undersic�ned ownedapplicanl hereby agrer.s to hold and save harm� <br /> Iess the G�y ol Everetl irom an�• and all claims for damages, costs, <br /> expenses, or causes of aclion �hal may arise br.cause of installation <br /> and maintenance ol the improvemen� or other right�oi�way use hereto <br /> applied for and turther agrees to remove same upon notice trom ihe <br /> Appro 1 for Construction Date Cdy and to ieplace public proUerty damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Sic�natme ol ApP�icant Date <br /> WORK AUTtiORIZED BY THIS PERMIT MUST BE STARTED WITH�N <br /> rverett PUBLICWORKS�EPARTMEN7 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3?�0 Cedar S�reet DE DILIGENTLY PURSUEO f0 COMPLETION.THIS PERMIT MAY 8E <br /> Everett.WA 99201 CANCELLED EV THE CITV UPON ANY STOPPAGE OF WOFK ON THIS <br /> Phone:259�0810 PROJECT OVER 90 DAYS DURATION, <br />