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� <br /> - --- --- -� <br /> Date�� �„���,�w�,.,��,,,m,�. 8-r{�y31�-- <br /> ADp��cation For emo Onn� • ��1�aaa.d�.__._ <br /> PUBUC WORKS PERMIT ��°°��°w°,�°�Oe- — <br /> m�,�r�P �- <br /> lessAnui irn Pe�n S_� <br /> naiT��:oo�� S��_ <br /> Print or Type Only <br /> i�, ,,,� �_,., I � �a�-GD'k.St-�c� �� E���et}-9�a(�� 3s5-�3� <br /> Owne� Madmo Atldress Giy Lp Phone <br /> p-ry��l�AM� I �� �ONL� <br /> —T�Appicant JtdaihngAAArrss � Gty Lp Phone <br /> Oesr.nbe Proposed Work _,'1/J'1d1�� -- <br /> f�.:eUAAdressUlknownl 77� �,(,�—�+ '--�/��1��� � <br /> � <br /> �lttach tour(4)copies of plans lor proposed work� Draw to scale and nole Ihe 1o11owing as apPlicable: � <br /> • Property Lin?s • Centedine of stree� � <br /> • Outl�ne and dimensions ol a�l ezistmg and • Indicate North <br /> proposetl structures on ihe lol • Show any propose.i grading changes <br /> • Ezisimg and pioposed uLhties • Show measurements � <br /> DO NO7 WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspoction shell be made 24 hrs.in adoance-phone Z59•881�. � <br /> 2.All work sha�l be pedormed in acwrdence wilh this permit and current City of Everett Design and Canstruction <br /> Standards and Spec;lications. <br /> 3.Call Location Underground Service 48 hrs.before you r.ic;.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> "'KNOWLEDGEMENT OF CONOITIONS <br /> The undersi9" �i ,vneUapplicant hereby agrees to hold and save harm� <br /> -- less Ihe Cit• f `: erett Irom any and all claims for damages, costs. <br /> � expenses, c� �.auses of action that may a�ise hecause oi installation <br /> /�{� � � and mainteri�ce ol the impiovement or other nghPol-way use hereto <br /> ��'/'� /�7eq"f=- applled Inr a„d further agrees to �emove same upon notice Irom the <br /> Approved for Constru/ n Date City and to replace pu6lic pro erty damaged themb�. <br /> � �71l��C.� J'�L G -dy %. � 7 _ <br /> FINAL INSPECTION Dale ' <br /> Approved as Conslructed Si9nat��re ol Apphcant Date <br /> WORK AUTI-IORIZED BY THIS PERIvLT 1dU5T 8E STARTED WITHIN <br /> everett PUBLIGWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cetlar Sireet BE DIUG[N7LY PURSUED 10 COMPLCTION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phane�.259�8810 PROJ[Cl OVER 90 DAVS OURATION <br />