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Date����`T-�� _ . ��,.�,., w.,..,��..,m.. <br /> � /'� ''�/ <br /> FpPticahon I�cn <br /> �..�,�,� n..�i . . L� S7��a--(_. .� <br /> PUBLIL WORKS PERMIT °°"°°W°�",�� <br /> ,o„���� _ <br /> �„=,.�n� �.��•.,,� s _ <br /> Print or Type Only ��,�:,�,�o,�� s_. _ <br /> ��a.L�� �� <br /> Owner Madmg Atltliess Cdy Zin Phone <br /> ApPl�cant MaihngAdA�oss - --C�t��- --- Z�p Phone -- <br /> Descnbe ProposPd Work �fv�`�—�+'y' <br /> �� � W <br /> Pro�ect Adtl�r.ss lil knowN � <br /> A�taCh�Ou�(4)Copies ol PIanS�or prOp05ed wo�k� Draw l0 5cale anA oie Ihe�ollowing as appficable: � <br /> • Property L�nes • Centerhne nl sireet � <br /> • Outlme and dimensions o1 all ezisting antl • Ind�cate North <br /> proPosed 5tructures on!he lol • Show any propo5ed grading changes <br /> • E.�shng and proposed utdiGes • Show measuremenis � <br /> DO NOT WRITE BGLOW THIS UNE O <br /> PERMIT CONDI�IONS <br /> t.All cails tor inspection shall be made 24 hrs.in xdvance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance wlth this permit and current Ciry of Everett Design and Construction <br /> Stendarda and Specifications. <br /> 3.Call Location Underground Service 46 hrs.before you diy.70LL FREE NUMBER 1•800-424•5555. � <br /> - � O <br /> �/�,��-�Y.�' �� �2 -;�-�B I— <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thc unde�signe0 owner/appllcant hrreby agrees to hold and ssve harm� <br /> less the Ctly of Everetl Irom any and all claims lor damages, costs. <br /> ezpenses, or wuses ol action that may arise becaus^ ol installation <br /> and mamtenance of Ihe improvement or other right-ol-way use hereto <br /> _ apphed for and lunher agrees to remove same upon no�ice irom the <br /> Approved for Conshuction Date Cdy and to repl.ce public property damageo thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslruc!ed Signature ol�pphcant Da;e <br /> WORK AUTl10RIZED BV THIS PERMIT MUST BE STARTFD WITHIN <br /> everetl PUBLICWORKSDEPARIMENT 1B0 �AYS OF DATE PERMIT IS !SSUED AND THEREAF1cR IS TO <br /> � 3200 Cetla�Street BE DIUGENiLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Everett,WA 99201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON TH�S <br /> Phone�.259-8810 PROJGC7 OVER 90 DAVS DURATION. <br />