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-350 <br /> `�� �c�� '� S � <br /> Date-LJs.�� � ��o��wo,��Po,m�_�. _f 7— <br /> Applica�ion For B�av o�°�.• ��,� <br /> ,_. <br /> PUBLIC WORKS PERMIT PuLbLW0�k5L90 <br /> To�A�Fea s <br /> LessPopl.FcePo�id S <br /> Oalenco�ua S 2��O <br /> Print or Type Only <br /> ��=����i �1i t'� i�i� i� �' St r,v ��a_ <���.a , ��a�u 3u��:�i�.� <br /> Ownd� Mailing Address City 2ip Phone <br /> J�YU l�k l� i�5 Sl�i I�) �Si- �'}�t<. �1R I�b �l�l- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _ ���L� L�1'lt � CT ! ��� � r � �) �/"1������� <br /> f-�IG�-}TS <br /> Prolect Atldress(it known) ✓/G� —����:'F�✓ •7(�� � <br /> � <br /> Attach four(4) copies ot pivns lor proposed work• Draw to ;�ale and nole the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> � Outline end d mensions ol all exisling and N Indicate North <br /> proposed stri ctures on tne lot • Show any propused greding changes <br /> • Exisling and proposed utili�'es • Show measuremenls � <br /> DO NOT WRITE OELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. A�I calls for inspection shall be made 24 hra in advance-phone 259•8815. � . <br /> 2, All work shell be perlormed in accordance wi�h this permil and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground �c�vice 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � ' <br /> T 5,���,E' SE/Zt�iC6'�,f Ti/iS f/nriSE u.iGL f,�vu,E i�� e� O ,' <br /> /'GMf'ED • A P,livAr M9.�HocE O,¢" TyE. Ci l/�t'O.Gc�. <br /> MUST d� 1�JST9CC6L� fat' TyF p,p�rv.cE [�yE To <br /> /�/Sc.t�.9�CGE /n/TO , TNEn/ �9 6 " vi9. �.�9v�r SinE � <br /> SELJ.SQ /n�Sr�9cCE0 //U TN.E' ST.t'Fc7- c�LT �Tj�/� �j�,K/ � , <br /> S �t"�Of- �'�F' 1>.rai.�if?G.e' 7c Q. � �� <br /> SG%'.Z;� /if/TO d�P9i�✓9�' SlJ9CF, <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save h�irm- <br /> less the Ciry ol Everetl Irom any and all claims for damages, c�sts, <br /> // expenses, or causes ol action ihat may arise because of install�ition <br /> .�Y_'_`,Q � ��� 2i�,7 and maintenance ol the improvement or other right�ol•way use h�reto <br /> %.K��% C>�C r� applied lor and further agrees to remove same upon notice fror.i the <br /> Approved tor C s fion Date City and to replace public properry damaged thereby. <br /> .��!�%�.C�/ „� - !%/��1� . <br /> FINAL INSPECTION Da�e /� - � Q/�'.G <br /> Approved as Constructed Si ature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERA9IT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet 180 DAYS OF UATE PERMI� IS ISSUED AND THEREAFTEP IS TO <br /> Everell.WA 98201 BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY BE <br /> Phonr: 255�8815 CANCEL:.ED BY THE CITY UPON ANY STOPP�GE OF WORK[lN THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />