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� <br />' Date_L�s Y <br />Applica�n For <br />PUBLIC WOI�KS <br />O <br />Print or Type Only � <br />a <br />Cd <br />O <br />/�� s���_� <br />� Majqng A�Q <br />� /10 /I 's <br />Applicant <br />Describe Proposed Work _ <br />Zc� G C <br />Project Address iif known) _ <br />PERMIT <br />gS <br />M M <br />M M <br />, � c��Y <br />�� �7 3// <br />Puolic\VorbPei���t� _Y�— ��� <br />eiae oew • <br />Pubbc Nb�ks Fce s <br />TOIAI FCO <br />l Pss Nppl. FCP PaIJ g. <br />�alance Ouo s 33 "—� <br />F v <br />2ip <br />Attach lour (4) copies of plans br propOsed work - Draw to scale and note the lollowing as applicable; <br />• Property Lines • Centerline ol sireet <br />• Outli�e and dimensiuns of a�l existing and • Indicate North <br />proposed structures on �hc lot • Show any proposed grading changes <br />• Ezisling and proposed utilities • Show measuremenis <br />5, <br />Phone <br />o'/ 3 S.>'-�.3s 6 <br />Phone <br />�o�s- <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City ol Everett Design and Construction <br />Stendards end Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />rL�ho.fa.L'G' � �n�c.eao� �vs,co>.� �l'ox7i�'c,0 4� <br />� .G� �il.� C�i�d �-t�ti Cdcr�e t�r�cr7v�i, , <br />s <br />�i-.Q-� `%.�'`e�. �+,a.is�a� � o�-cn.��J��.O � �� <br />�.t�C��'ctiG•�rrr� ��,:�.c�7"ov �.�/i 2.i .�•n!%a� <br />evcrett PUBUC WCRKS DEPARTMENT <br />� 3200CedarSireet <br />Everett, WA 9N201 <br />Phone:259-88�0 <br />W <br />� <br />— <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWI.EDGEMENT OF CONDITIONS <br />The undersigntd owner/applicanl hereby agrees to hold and save harm� <br />less the Ciry ol Everett Irom any and all claims lor damages, costs, <br />ezpenses, or causes ol aclion �hat may arise because of installation <br />and mainlenance of ihe improvement or other ri�ht-ol�way use hereto <br />applied for and lurther agrees to remove same upon notice Irom Ihe <br />Cily and to re�ace public property damaged thereby. <br />i> � �� S� '- O �G <br />Signature o) pplicant Date <br />WORK AUTHORIZE BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERM1IIT IS ISSUED AND THEREAFTER IS 1"O <br />BE DILIGENTLY PURSUEf1 TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />