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;� <br /> Date�—�;--� ' � P„�,�,�w�,�����,m.i <br /> �PPl�ca�icn for Euaq Dnni . ._ <br /> -�_i��3� <br /> PUBLIC WORKS PERMIT �����;�W�;;���s --- - --- <br /> Lese�nni i-nr pnnf S <br /> I int or Type Only or�a�;,.n„� S Z� <br /> �' ��'( �11 li,!�''�7 (�7a'D��Y;1'C't�l� ��i�� �fi�� '�-I <br /> .�'�.�i��ft� , ���� <br /> Owner Mailing Ahdress C�ly Zip PhOne <br /> �\ 11 <br /> ApP���ant Maihng Address City Zip Phone <br /> ,��Descnbc Pioposcd WJrk � I � � <br /> Pro�ect Adaiess lil knownl �y'a� A�..B c..S�l,/�CG� �.CX. � <br /> � <br /> AI�aCh IOw 14)Copies OI plans fOr'� ��0>ed wOrk� DrIW lo Scale and noie Ihe lollowing.ls apUhcable � <br /> • Property Lmes • Centerhne ol streel � ' <br /> • Out�me antl dimensio��s of all eaishng antl • Intlicate Norih <br /> proposed structures on Ihe Io1 • Show any proposed grading changes <br /> • E.ishng anG proposed utilities • Show measurements � �, <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O ' <br /> 1.All calls for inspection shell be made 24 hrs.in:.ivance•phone 259•8810. � <br /> 2.All work shall be peAormed in eccordance with this permit and current City of Everett Design anA Construction ( <br /> StanEerds and Specifications. I <br /> 3.Cell Location Undergrountl Service 48 hrs.befcre you dig.TOLL FREE NUMBER 1-800-424•5555. � i <br /> O '� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unAersigned owner/applicant hereby agrees to hold and save harm- <br /> luss Ihe Cdy ol Everett irom any and all claims for darnages, costs. <br /> � eKpenses, or causes ot action tha� may anse because of installa�ion <br /> ������� /���� and maintenence of the improvement or other righl-ol�way use hereto <br /> �V apphed lor and lurther agrees to remove same upon notice irom the <br /> Approved lor Const ucti � Date City anA lo replace fiubllc property damaged ihereby. <br /> �-//` 3-G -so � / -/ � u�/ <br /> FINAL INSPECTION Date `✓� /��^'�J'� �^ �/— " / <br /> Approved as Consvucted Signature ol Apphcant Dale <br /> everett PUBLIC W'ORKS DFPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITH�N <br /> � 3200CedarStreet 180 DAYS OF DATE P[RMIT IS ISSUED ANO THEREAFTER IS TO <br /> Everett WA 992u1 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED B'f TIiE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />