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Dat@ � ��s Puebc won.Permn. U�02� � <br /> B�Jp.Dept• <br /> Appliut�on For <br /> PUBLIC WORKS PERMIT PueTof�l eeFee f <br /> Lees�po�.Fee Paio � <br /> B�innce Due { <br /> Print or Type Only � <br /> JciNN �L�%Kr I"I• ' Cd L�c PO �r C`�Of�O �utQu'tt 4l/� qd'Z06 <br /> Owner M iling AdAress City 2ip Phone <br /> �� �0�lRC--`I N iAYxoQ �° �� cgo4o �'u�z,�cf� 9c'aQG 356 - 5�J'� <br /> Applicant Mailing Address City Zip Phone <br /> Deecdbe Proposed Work 9U� K t J � c�_s� '�x� �a• n"` `^��� �C`z-���r� <br /> � J <br /> Prolect Addresa(it knownl At 1 rJ/=J.L� �p � � � ���' �Jv x u`�� ` . � <br /> � <br /> Attach four(4)copies ol plans lor proposed work• Draw lo scale and note the 1o�loaing as applicable: � <br /> • Property Linas • Centedine of streel � <br /> • Outline and dimenaions ol ell existing and • Indicate North <br /> p�oposed structures on th��-lot • Show any proposed greding changes <br /> • Exlsting end proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEHMIT CONDITIONS <br /> 1. All calls tor inspaC[ion shnll be made 24 hrs. in advance-phone 259•8g1 5. � <br /> 2. All work ahall Ae parformed in accordance with this permit and current City o1 Everetl Design and Construction <br /> Standards and Specificatlons. <br /> 3. CaU Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•8U0•4Z4-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF COIJDITIONS <br /> ihe undersigned owner/apphcant hereby;grees to hold and save harm• <br /> — less the City ol Eve�etl from any and all claims for damages, costs, <br /> expenses, or causes of action �hal may arise because oi installation <br /> �S� /Jy /�S� �� and maintenance ol the im�+rovement or other right-of�way use hereto <br /> ,1i G'�� applied tur antl further agrees to remove same upon notice irom the <br /> Approved for Co��tion ��Date City and o replace public p�operlY dam �d thereby. <br /> � 3�� � � <br /> �� � �� � . _- � - �� -� ' , - - <br /> FINAL INSPEC ON Da�e `" �� <br /> ApFroved as Constructed �'�' �E� �� - / Signature A icant Dete <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLI^.WORKS DEPARTMEN7 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett,WA 98207 CANC8LLE0 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 9(l DAYS DURATION. <br />