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Date�G9'�� � vuei�cWoresPermd• ����___ <br /> � <br /> Application For ei,i�.Ueo�-• <br /> PUBLIC WORKS PERMIT ruorcworhsrea � � <br /> Toiel fee s ��' � -- <br /> Les!A00��Fea Peltl S�a� <br /> B010nC!Dup S �G <br /> Print or Type Only <br /> �A,� �j�s�� <br /> I�o �> Gu N►s,���; r_��2��-� 3 3� - �� r z <br /> Owner Nailing Adtlress Ciry Zip Phone <br /> �o [� Cvl-riSM/�,v EvtP-r�� 337 -o�trt-- <br /> Applicant Mailing Adtlress Ciry Zip Phone <br /> Descri6e F'roposed Work Q`�L k �T 1 R O.M 1" ��� t R r`� L. I N G �O C�t`( $ ]�(.EEr <br /> �vat`c� /s Uu�'��Or �F cY��/ c��1,'/TJ' — frfi�.�E'�'E� <br /> �.f'oirlT.(' O/1� C�'ii s/ p/` �.�c�'i:i /(a O. Gc.>, <br /> Project Address(il known) //.G `—�� �J'C�i\ ^ '�c � vL � <br /> � <br /> Attach lour(4)copies ol plans lor proposed work- Draw to scale and no�e the tollowing as apPlicable: � <br /> • P�operty Lines • Centerline ol sireet � <br /> • Outline and tlimensions ol all existing and • Indicate North <br /> proposed slructures on the lut • Show any proposed yrading chan9es <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITICiNS <br /> 1. All calls lor insPection shall be made 2» hrs. in advance- phone 259-881 5. � <br /> 2. All work shall b��perlormed in accordance with ihls permit and currenl City ol Everett Design and Construclion <br /> Standards and Specilications. <br /> 3. Call Lecation Underground Service 48 hrs.belore you tli�.TOLL FREE NUMBER 1•800•424•55SS. � <br /> � ��£'�c�c9�T /.Y' /`��9//�i�t'�' /� /����i<o�J o,�' O <br /> C'/i� :J F Ev��c'�rT �? c9. t,c,. .Oi�/�i�G� � <br /> ��'c�/7? %f�c ��'LJ l`'/�!/Lr'�cTi�'T �1�'y� � � <br /> �.�c�cJ oN Ta i9f'f'<<c�9�7's /�oE'i//�i�'/�o �, <br /> ���"C l c.y�v i /s �wi9�c o� ir��J' �o�•4oii�o.� O <br /> ll�"' ��� h6�`aS" <iTy i`/�9iC''/�Gc�P, a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicart hereby agrees to hold and save harm- <br /> less ihe City of Everel� Irom zny and all claims for damages, costs, <br /> expenses, or causes of aclion that may arise because of installation <br /> ���� and maintenance of Ihe impro�iement or other right-ol-way use hereto <br /> � applied for and lurther agree� to remove same upon notice Irom the <br /> Approvp �for s ction � �eie City and to replace public property damaged thereby. <br /> � + : <br /> (IIJ� <br /> ; ��-`�'�M-� L � �_. � 3 _�— ���7��^��,,,,.-- IO- r'7 �8`1 <br /> FINAL INSPECTION \ Date <br /> Approved as Constru `d) \ Signature of Applicant Date <br /> everMt PUBLIC WORKS DEPARTMENT WORK AUTHORRED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 780 DAYS OF DATE PF:RMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everet�,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />