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. ; <br /> � <br /> Date_������� v�nnc wo���v��mit /�n � <br /> ema Deo� • � ��C�� -- <br /> Applicatiun Por <br /> PUB�IC WORKS PERMIT °°°'�°`°°�'°`�° -_ <br /> ,o�.�F« s <br /> �ens�oo�.re.aa�a S <br /> 4�� b:�a�co oue S __ <br /> rj� Print or Type Only <br /> 9�3 <br /> C�H <br /> t-� z"' �f�n ��ln-llnt/,� �C.' 770 ��C1� (�' �•'f.9Pt� ��'1�/� /='/7. .��/S!7 <br /> y �H Owner Mailing Adtlress / ��Y ZiP Phone <br /> o xo �i,� ��Oln7 � 2:7`�-/3/l <br /> � ~� Ma�lm Adtlress Gty Zip Phone <br /> V1 H AppGcant 9 <br /> xzr • <br /> r� o�i �7� `� / %.�r/'1z! . �'�.�L' <br /> y Cy Describe Proposed Work — <br /> OH V <br /> H C��7� — ' <br /> n� o <br /> zy� _ � <br /> � y y Project Address(it knownl —!�'4�-----E�-L.-u^-�."`�-"--=' � , <br /> H ! <br /> O C7� Attach iour�4)cop�es ol plans lor proposed work-Dra�H lo sca •and note the lollowing as appliCable: � <br /> 3 �t+ • Property Lines • CeNedine ol street ♦^ � <br /> �j� lT. • OuUine and dimensions ot all existing and • Indicate Norih �� <br /> H O C/.0 proposed stmctures on Ihe lot • Show any proposed gratlmg chanyes � <br /> • Ezisting and proposed utilities • Show measuremenis /� <br /> — DO NOT WRIT[ BELOW THIS LIN[ � � <br /> PERMITCONDITIONS O i <br /> 1.All ca!I5 br inspection shall be made 24 hrs.in advance�phone 259•8810. � <br /> 2.All work shall be oedormed in accordance with ihis permit and curtent Cily ol Everetl Design and Constmction , <br /> Standards and Specifications. , <br /> 3.Call Location UndergrounA Service 48 hrs.before you di9.TOLL PREE NUMBER 1•800•424•5555. ��� <br /> f� �� <br /> �� _ O . <br /> �"' — •GC�;� �.����_ /o�, ,.t.�l�. r��•Y�,�<' �� <br /> ' �i :C��L:� � . <br /> �_ ��� <�� <br /> �' � <br /> �� /��'` O <br /> �s � � <br /> ... � <br /> II~Y �' ACKNOWLEDGEMENT OF CONDITIGNS <br /> +.. ,.�► <br /> The undeisigned owneUapPhcanl hereby agrees to hold and save harm� � <br /> — less ihe City ol Everett Irom any and all claims icr damages, r,osis. <br /> ..� � erpenses. or causes of action ihat m�y anse heczuse of installation <br /> ��� and mamtrnance of the improvement or olher riPub�obway use i�ereto , <br /> applied lor and luriher agrees to remove same upon notiee Irom Ih� <br /> Ann�o�ed io�consvuction ���� City and�o raplace pu6lic properly dama� �d Ihe�eby. <br /> FINAL INSPECTIOW Date I <br /> ApP�ovetl as Constructed Signa�ure ol Applicant Date <br /> � PU�IICWORKSDGPAR7MENT WORK AUTHORIZED PY THIS PERMIT �dUST �F STARTED WITHIN , <br /> 180 DAVS OF DATE P[FMIT IS ISSUED AND iH[REAFTEFi IS TO . <br /> 320oCedar Streel B[ DILIGENTLY PURSUED l0 COMPL[TION. TH;S PERMIT IdAV 8[ <br /> Everott.WA 9B2C1 CANCELLED�Y iHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc�.259�[iB10 I'F70J6CT OV[R 90 DAYS DURATION. � <br />