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��/ Pupur.Wmxs 1'ermn• <br /> Dete 15�9U niea o.o� •�n /,J�/✓� <br /> Applicalion For �'�- <br /> PUBLIC WORKS PERMIT ���To�Fee��� : <br /> lesa Rnn�Pee Pxio S <br /> .ialancrOun S�. <br /> Print or Type Only <br /> �� d- �Q.� 7/UJU,� I(�eZfl Lt l � ly;�� i,/� /r'_i' ���f� <br /> Owner Maihng AAdress City Zm Phcne <br /> G , �p„�a ��.,,,a- G, any� � - r,'hA�.e.. c� ��i�....,�,., �-.�� ��.�-���� <br /> Appllcant Mailing AtlOress Gry 2ip Phon= <br /> Destribe Proposetl Work _. <br /> . W <br /> Project Address lil knownl J � <br /> Aflath tour(4)copies of Plans for proposed work- Draw to scale and note the following as appl�cable: � <br /> • Property Lines • Cecterline oi street � <br /> � Outline and dimensions of all ezisting antl ! Indicate North <br /> proposed structures on the lot • �huw any Uroposed grading changes <br /> • Ezisting and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O '� <br /> PERMITCONDITIONS � i <br /> 1.All cells lor inspectlon shall be mede 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peNormed!n accordam••with Ihis permit and wrrent City o1 Everetl Desian end Construction j <br /> Stendards end Specifications. � y <br /> 3.Gell Lxation Underground Service 48 hrs.belore vou dig.70L1 FRE'E NUMBER 1-80�-4245555. i <br /> � I <br /> /' / ,, ,+ ',l /'_ �.� � , .f . ( <br /> �rU��2r� CG�O�i''-i f f'''1 .��,a f /� : . ` � � <br /> / � � <br /> ��, ,,�.�1 � � <br /> Kt�-�/i ."' _ n /.r1�1' f''�O�a �`.�'t.z' r; r- ` <br /> ��u p <br /> � �f��-�,� af�u�y �� O <br /> ��` a <br /> lti <br /> ° - ? C' <br /> 7-/ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrePs to holtl and save harm- <br /> Iess the City of Everett from any and all cla;�.:��•�� �or damages, costs, <br /> ezpenses, or causes ol action that may arise because of installation <br /> and maintenance of the improvement or other right�of�way use herato <br /> applied for and Wriher agrees to remove same upon nolice trom the <br /> Approved tor Consiruction Date ��ty and to replar,e puUlic property damaged ihereby. <br /> FINAL INSPECTION Da�e Date <br /> pppro�etl as Construded Si9nalure ol �fPlicanl <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEf? IS TO <br /> � 3200Cedar5lreet BE DILIGENTLY PURSUED TO COMPLE?ION. THIS PERMIT MAY BE <br /> EverelL WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORY.ON THIS <br /> Phore:259�9870 I PROJECT OVER 90 DAYS DURATION. <br />