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� i r� ;'c S� ,r.l� '� S <br /> ✓� <br /> Date�3�8��9' �`��I'i ��„�,�,�wo,,,��,m(���. _��J'�7 <br /> � �� �U-�'�� uino oon� • _tF'7 !��// —_ <br /> APulir.at�on for _'______ <br /> F�UBLIC WORKS PERMIT ''°°°`""°,"�'e s <br /> ,o,.���. <br /> ��•ss nnm r.P na�a s� <br /> a.�r���o�,. s 2C� <br /> Print or Type Only ` <br /> � l r- ,.. , Y �d(a .5�..�� U. ��PinTf' 9d Zc 3 3y)��G� 7 !. <br /> 0�`�" Madmg Aaress CiIY Zip Phone � <br /> i <br /> qp lican <br /> Maihng AdAress Cny Lp Phoae <br /> irrlAi P(ls�jq j l�Jp��Qtj� �—Q��"7�c��.=�,/Q�-� <br /> Uescnbe Propose0 Work �–.-�1?lY� J � � <br /> I <br /> - W � <br /> Prolect Address lif hnownl <br /> ��/�)�C.r2r...�� CLt.�P , � � <br /> � <br /> Aflach fow(41 cop�es ol plens lor P�oPosed wo�k� Draw tc scale and note Ihe lo�lowing as apPhcab�e: � �. <br /> • Property Lines • Centerlme ot strr.el <br /> • Outlme and dimensions oi all eKislmg and • Indicate North <br /> proposed siructures on Ihe lot • Show any proposed grading changes �'� <br /> • E.istmg and proposed utildie: • Show measurements M : <br /> W <br /> DO NOT WRITE BELOW TH�S LINE O �. <br /> PERMIT CONDITIONS � <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.AI�work shell be pertormed in accordance with this permit and current City ot Everett Design and Construction <br /> Stendards and Specificatlons. � , <br /> 3.Call Locetion Underground Service 49 hrs.before you dip.TOLL FREE NUMBER�•800�424•5rJ55. <br /> O <br /> � <br /> � <br /> � <br /> a <br /> �CHNOWLEDGEMENT OF CONDI1lON5 <br /> � The undersigned owner/applicant�e�eUy ag�ees lo hold and save harm� <br /> less the City ol Everett Irom any and all claims lor tlamages, costs. <br /> ezpenses. or causes ol action Ihat may arise because ot installation <br /> > > and mamtenance ot ihe improvement or other righl-ol-way use hereto <br /> �; - –� 1�,'� '-� � ��.� applmd tor and further agrens to remove same upon notice Irom the <br /> Appreved lor Gonstruct Dale City and to replace nubllc properry damaged thereby. <br /> �r� l— o�=� r-� ' '� - ��9-� <br /> o,�� �.,._ ,�_.--__--- <br /> FINAL�NSPECTION /�� Date <br /> Signat o�APPI ant <br /> Approved as Constiucted � / K AUTHORIZED BV 7HIS F�RM�T MUST BE STAtiTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1B0 D�vS OF DATE- PERMIi IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLV PURSUED TO COMPLETION.THIS PEFMI7 MAY BE <br /> Evere�t,Wq 99201 CANCGLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB1� PROJECT OVER 90 DAYS DURATION. <br />