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Date-- - ��,�,�_. w,,...��..,m,�. _ ���1["1�_ <br /> APPLca�ien Por tany c�,n� . <br /> � PUBLIC WORKS PERMIT ":°;�,,w;��;`��e�=sz�-_7'_ <br /> i....anw 1..,i:�x.S <br /> Print or Type Only ��''^ � "�� s���- <br /> :'; `,� <br /> �' �;; � ; : <br /> �i ��i i ; � <br /> ,!� - �. <br /> L'/��FCL�[ Na7/I �1� i � o� ., �. „ <br /> u <br /> wne� Mailing AAtlress p� � '�� ' ' ,��� 7_ip Phone <br /> C�� r�l [.. Y -.' <br /> �y I�l . u ] �,> <br /> �����j� .r r�irr /��`� ��\ l.�-.s,-� �j�r1� 2S`Z //l G <br /> y l l� 1 <br /> phcaM Mailing Address � Gly Zip Phone <br /> � S�r f- f�l r �� /? �) �j9 <br /> Descnbe Pro osed l4ork U�r Gf 1f� �� /�U� _�C' -C7 <br /> W <br /> Pro�ect Adtlress Uf nnown) —� � � <br /> Attach lour 1<I copies of plans for proposed wo�k � pravr to scale antl note th�followmy as anPGcable: � <br /> • Property Lmes • Cr.nterGne of sireet � <br /> • Ou�line and tlLnensions of all existing antl • Indicale North <br /> pruposea siruc�ures on Ihe lot • Show any proposed gradmg changes <br /> • Er.ishng ane proposetl utilnies • Show measurements � <br /> DO NOT WRITE BELOW THiS LINE O ��� <br /> PEFMIT CONDITIONS <br /> 1.All Calls tor inspection shall be m3de 24 hrc.in advance�phone 2$9•88�0. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standerds and Specifications. <br /> 3.Cell Location UndergrounA Service 48 hrs.before you dig.TOLL fREE NUMBER 1-800�424•5555. � <br /> 'l. /�`'I' [�/U„��p��' (/�/`�t�� �U '�8 -b� O i <br /> // � ; <br /> � <br /> � <br /> � � <br /> a <br /> ACKNOWLEDGEMENT OF CONDIIiONS <br /> Tne un<;ersi9ned ov;neVapplicanl hereUy agrees to hold and save harm� <br /> � less the Gty ol Everett irom any and all claims b� damages, costs. <br /> j/' e.pens ,vr causes ol action that may a�ise because ol installation <br /> /_�%� and int�nance ol Ihe improvemenf or other right�obway use herelo <br /> ap �ed lor and lurther�agrees lo re e same upon notice rom ihe <br /> Ap �d for C�N� Date C y�nd t replace puyhc pronerry maged Ihereby. <br /> / /_ <br /> C' <br /> , �y.lv� �� ���JrU � . , -. . / <br /> FINAL INSPECTION Dale ' � � � <br /> Approved as Constructed , Sg� afwe o)�Applicant �� ' � ' � � Date <br /> WO(iK AI�THORiZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENiLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett,WA 99201 CANC[LLE7 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.259�8810 PROJ[CT OVER 90 DAYS DURATION. <br />