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� ' <br /> " �` 1 <br /> � �'� _��� � ��„�,�,�wo,.,�.,m��. �1—Z <br /> �Date_� <br /> . uinn D�n� • . — --- <br /> ApUlicatfqn For <br /> PUBLIC WOF�(S PERMIT °°^,","°„""° S-- - <br /> to�ni rm <br /> "�� tess a�w FnP Pe�n S_ <br /> '�o a.�r��o o�� S ..7 7��;�,— <br /> Print or Type Only = � � <br /> O�Dpy Hef3ri�C G�, � �J� « M <br /> �sr'3��`/ t'E'�"'� o ����i�,oC U 1�v /3o X Z S' Ev�REr GIJ��dN1D6 �5 y-7/Z8 <br /> Owne� Ma�T�H�gps,. C IY Z p Phone <br /> o � �— � <br /> � � u <br /> qpphcant Mading Addiess City Zip Phone <br /> DesttibeProPoSeAWork TNST/9Ct� 1L�00 H�L�-0� l(_ (�>pTFiP GF/JF. .P� TG2 <br /> n u ►,.. Lv � /�'�c �-�t' ��/� f <br /> W � <br /> Pro�ect Address Id known) <br /> ��`' S�s� i TH ST �[/E/Z E!T /1Jl9 �, i <br /> Attach lour 14)cop�es o�Plans lor Proposed work� Drew to scale and note Ihr,lollowmg as applicab�e�. � I <br /> • Property Lines • Centedine ol street <br /> • Outlme antl dimensions of all ealsting antl • Indicate �:orth I <br /> propose0 siructures on t�e lot • Show any proposed graGing changes i <br /> • Ezist�ng and proposed utillties • Show measurements M I <br /> DO NOT WRITE BELOW iH�S LINE O I <br /> I <br /> PERMITCONDITIONS � I <br /> t.AII calta tor inspection shali be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work ahall be pedormed in acwrdance with this permit and current City ol Everett Design and Construction � <br /> Standards and Specilications. <br /> 3.Call Localion Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1-BOO-424•5555. � i <br /> 1���,,f �, L�� �:�=�;.. ��� . ,, tr;�,•/:�r,-r�,�`: Q � <br /> I <br /> � I <br /> � i <br /> 0 <br /> a <br /> ACNNOWLEDGEMENT OF CONDITIONEi <br /> 7he undersigned owner/appliwnt hereby agrees to hold and save harm� <br /> - less the City o1 Everet� irom any and all claims lor Aamages, costs, <br /> e�penses, or causes ol action Ihat may arise because of installation <br /> �j� � / /��Y and maintenance ol Ihe improvement or other right-obway use here�o <br /> �� ' ��1��� � applied lor and lur:her agrees to remove same upon notice from ihe <br /> Approved 1or Construction a�e Cily and t�ace public proPerty damaqed thereby. <br /> i <br /> � f/-/7- � � � ,. � � <br /> AL INSPECTION �`�� Date <br /> Approved as Consiruc�ed ghature ol Appli <br /> WORK AUTHOR BY THIS EFlM MUST f3E STARTED WITHIN <br /> everetl PUBLICWORh'SDEPAR7MENT 1g0 DAYS OF TE PERMIT tS 5 UED AND THEREAFTER IS TO <br /> � 3200 Cedar Stnxet BE DILIGENiLY PURSUED TO COMPLETION.TNIS PERMIT MAY BE <br /> Everett,WA 58201 CANCELLED BY THE CITY UPON ANY STOPPAoE OF WORK ON THIS <br /> Phone�.259�BB10 PROJ[CT OVER 90 DAYS DURATION. <br />