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Date��L'F�g°I ^ - �„„�.�,�,�,,.���,�„�. ---- <br /> ApPlica�ie:, �oi o�nq Den� . �t_��63_�-_--.-. <br /> PUBLIC WORK� PERMIT ��°�°—°W°,.°��.P-------_ <br /> loia�[en s'_ <br /> � loss Anui :ne Vx�U S _ <br /> Baiaricr Dun S_ <br /> Print or Type Only <br /> _g-ad��e� �0 8o�c r�9 q �=�e.�p 9�,�� G as�- 366� <br /> Owner Madmg hAd�ess C�ty Lp Phone <br /> ���ir��' Mailing AAdii'ss GI1'--�-- Zip PhunO <br /> Desc�ibe Proposed L1brk �1�Q�1� �M d!�PN T �C7 / �M,/` "7a.!' Jl� �Y- 1/U fV(0� <br /> Proiect Adtlress lif knowol � 7� � �q�l"� ��—�l�J� � <br /> � <br /> Attach lour 14)copies ot plans lor pioposr.d work� Draw to scale and notr. Ihe lo�lowing as appllcable: � <br /> � Property Lines • Centedine uf street � <br /> � OuUine and tlimensions ol all caistinB and • Indicale North <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Ea�Sting and proposed utih�ies • Show measuremenl5 M <br /> W <br /> DO NOT WRITE 3ELOlN THIS LINE O <br /> PEHMIT CANOITIONS <br /> 1.All calls for inspectfon shall be made 24 hrs.in advance-{�ho�:e 2S9•8810. � <br /> 2.All work shall be pedormed in a� cordance with this perm!1 and cc«r:r.t City of E�erett Design and Constructlon <br /> Stendards and Specifications. <br /> 3.Call Locetion Underground Service 48 hrs.bei�re you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � > � �, �,,,�: �1('�1��f' /.c'�i�t-t�'�' O <br /> f;f�f�t lr-'�t� 1-✓ i� � <br /> •-�Og��<-,�� <br /> ,� -�-� -,y°� � <br /> � <br /> � <br /> a <br /> ACKNGWLEDGEMENi OF CONDITIONS <br /> The unde:sigr:ed ewneqapplicanf hereby agrees to holA�nd save harm� <br /> ---- — less the C�ty ol Everetl Irom any and all claims lor Aamages, costs, <br /> exoenses, or causes oi 2ction ihat m2y arise because ot installalion <br /> and mainlenance of Ihe improvement oi other right-ol-way use hereto <br /> applied lor and lurther agrees to remove same upon noUce Irom the <br /> Approved for Construdion Dale �ity and to replace public property damaged ihereby. <br /> FINAL INSPECTION Dale <br /> Approved as Construcled Signature of App�icant Date <br /> N�ORK AUTNORIZEU BY THIS PERMIT MUST BE STARTED WITFiIN <br /> everett PUBLIC WORKS DEPAR7MENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br /> � 3200 Cedar Slreel BE DILIGENTLY PURSUED TO COMPLETION. THIS P[RfdIT MAY BE <br /> Everetl,WA 90201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOPK ON THIS <br /> Phone:259�B8t0 PROJECT OVER 90 DAYS UURATICN. <br />