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` $' 1%2 I ��— <br /> Date�C�q TQ POSTING � -�= � sq9-Z�3 <br /> P��bM1C WDrhS Pe�mil a <br /> APPlication For Biny oeni . . ,S-Q /�/�Z_�__ . <br /> PUBLIC WORKS PERMIT - T����R�� -- <br /> VULhc Wmtsfce <br /> lO�A1Fpf S <br /> � LessPn01 f¢rvPai� � <br /> Print or Type Only oaw��,.n�� s �O�— <br /> _i:�ck f��6�'¢� /rn u/oQal/n�.��__�vP� Yf 9 8za. �. , sa - �/ <br /> Owner Mailing Adtlre55 C��y T7a�_ <br /> Z�p Phone <br /> �Sa�.,� . <br /> Appheant Mailing Address ���Y Z p <br /> Phone <br /> Describe Proposed Work <br /> � ' <br /> t ' � � <br /> Pro�ect Atltlress(if knownl - •3�i (?9 - J//-� f Sy= � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note Ihe tollowing as apulicable: � <br /> • Property Lines • Centedine ol street — <br /> • Outline and dimensions of all ezisting antl • Indicate North � <br /> p�oposetl siructures on the lol • Show an <br /> • Ezisting and proposetl utilities Y P�oposed grading changes <br /> • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONUITIONS O <br /> 7.All calls foi inspection shall be made 24 hrs.in advance•phone 259-8810. <br /> 2.All work shall be peAormed in accordance with this permit and wrrent City of Everett Design and Construction ' <br /> Standards end Specifications. <br /> 3.Cail Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � <br /> O <br /> � <br /> � - <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIC��';i <br /> _ The untlersigned owner/applicanl hereby agrees to hold and save harm� <br /> less the Ciry ol Eveielt Irom any and all claims for damzges. costs, <br /> / � / �:J p ezpenses, or causes of action that may arise because of installation <br /> ( /�//7�U i�_ <br /> �'� - �C'O�y O and maintenance o� the improvemeM or other rlght�of�way use he�elo <br /> Approved lor Construytibn � pa�e applied lor and further agre999s to remove same upon notice Irom Ihe <br /> �/ Ci1y and to replace public prbperty damaged ihereby. <br /> -��l'��� /D -? Y-% _ � I <br /> FINAYINSPECTION Date �- -k9 <br /> Approved as ConslructeC �"'� � � 7- L-"� <br /> Si ature of qpplicant ��� �u '—"�— <br /> everett PUOLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 �3E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV 8E <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />