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O O p�j pupM1c Warh�Permil• �-+� _ �T �. .'�..� <br /> Date� e��iA o�ai . BG� — /b 976 j <br /> Applicalion For ' <br /> PUBLIC WORKS PERMIT �ulih<WorwsFee s — + <br /> TOlnl FBB <br /> Lefa np0��Fee PBi� s I <br /> eainncaouo S �0�� I <br /> Print or Type Only <br /> f 9i0 <br /> Ef/ if'�.�iG,�.T Pa 8oX B90 h�u���•-Eo 98175 3.�7- 099� <br /> Owner Mailing Adtlress Ci�y 2ip Phone <br /> sA�� <br /> Applicant MaiGng Address Ciry 2ip P�one �� <br /> Describe Proposed work NEuJ S• � Q� <br /> � <br /> _ W <br /> Prolect Address�il known) .� �B�.3 — S/L✓E�f' LA.CE �� � I <br /> Atlac�lour(4)copies ol Ulans lor proposed work• Draw to scale and note t�e following as applicable: � <br /> • PropeAy l:nes • Centerline ol streel � <br /> � Outline and dimensions of all existing and • Indicate North i <br /> proposed structures on the lot 4 Show any proposed grading changes '� <br /> • Existing and propo9ed utilities • Show measurements � M <br /> DQ NOT WRITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS <br /> 1. Ail calls lor inspectlon shall be made 24 hrs. in advance- phone 259 881 5. � � <br /> 2. All work ehell be peAormed in accordence with this permit and curreM City oi Everett Design and Consiruction <br /> Standerds and SpeGfic3tions. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> � �it�„aiG f�vuSE ON TN�S LoT jo BE �E�>�✓� O �; <br /> O�P %GR� l70u//+� . <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> , c� � . The undersiyned owner/applicant hereby a9rees to hold and save harm- <br /> less ihe Ciry of Everelt from any and all claims br damages, cosis. <br /> � ezpenses, or causes ol action that may arise because of installation <br /> • -/��� B�g/�6 and mzintenance of the improvemen� or other ri�ht-ol-way use herete <br /> �G/tL apPlied for and Wrther aqrees to remove seme upon nolice irom the <br /> � Appro�ve or onsUudion ��Oate City and to replace public properry damaged Ihereby. <br /> //�,_�,������� �> > v �� . p � <br /> FI�INSP CT ON `' � � a�0 Datc <br /> Approved as Construcled Sig a e of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PURLIC WORKS DEPARTM[NT 7g0 DAYS OF DATE PEFMIT IS ISSUED A':D THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTL'�� PURSUED TO COMPLETION. THIS PERA9IT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE Of WONK ON THIS <br /> �hone: 259-881 5 PROJECT OV[R 90 DAYS DURATION. <br />