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. ,� . . - . , _ _ <br /> Date_6�V�/V �'�ni�cwm�sr,,,mn• _ <br /> ' Applic�Iion Por OmV Oem • <br /> PUBLIC WORKS PERMIT �"„°=w�,�,��� <br /> Tote�rcr S <br /> les3 Pppl Gee Paul S <br /> Print or Type Only flaianco Dun s <br /> Ma�k, CT,�pI�� �Il�l� S�I�evl � I.a�c C��,u,i� � g.7L3 :L �.�— /.6�9� <br /> Owner \ Mailing Adtlress City ip Phone <br /> S o.�^*E <br /> Applicant Malhne�AAdress � City Zip Phone <br /> DescribeProposedWark NS'h' S � VQTq�N�� V�R.VI 0� VGr�V00.µ '�"IQ.s l� ✓0� <br /> ( o �oti 0� �so-M.k �.�,..� +t� �./a9.� <br /> c-ov�b� ��� C; � �� , —-�n/ �� (n6o+a u/ �k Ma.v�� <br /> ���, �,.� c�.�,;�� � � w�� � � � ��- W <br /> Prolect Address(ii knownl ��' � 0.� — S� .. � <br /> Attach four�4)copies ot plans lor proposed work- raw to scale and note e lo�lowinq as applicable�, � <br /> • Properry Lines • Centerline ot sireel �� <br /> • Outline ard dimensions of all existing an • Indir,ale North <br /> proposed s�ruclures un the lot • Show any proposed gradmc�changes <br /> • Ezisling anE proposed utihties • Show measurements � <br /> DO NOT IT BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shell be mude 24 hrs.in a van -phone 259•8610. � <br /> 2.All work shali be pertormed in eccordance with his per it anA curren�City ol Everett Design and Construction <br /> Standards and Specitications. <br /> 3.Cell Locetion Underground Service 48 hrs. fore you dig. OL.F�UMBER 1•800•424•5555. � <br /> ��� � <br /> Z <br /> �� � <br /> � 0 <br /> �� a <br /> ACKIJOWL�EDGEMENT OF COND�TIONS <br /> The undeisigned owner/ap�cant hereby agrees to hold and save harm� <br /> / less Ihe City ol Everett iro�any and all claims tor damages, costs, <br /> erpenses, or causes ol acho ihat may arise because ol installafion <br /> and maintenance ol the improvament or other right�ol�way use hereto <br /> applied lor and lurther agrees lo remove same upon notice Irom thE <br /> Approved for Construdion Date City and to replace publlc property�amaged ihe�eby. <br /> FINAL INSPECTION Date - <br /> Approved as Consiructed Signatun:of Applicam Da1e <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STAIiTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSUeet BE DILIGENTIY PURSUED TO GOfdPLETION. THIS PERMIT MAV BE <br /> EveretL WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJ[CT OVER 90 DAYS OURATION. <br />