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Date '� r���ouc wons r�,mn. 9��g <br /> ��1$�9� Bina ocoi • - <br /> M ApPlir.ation For <br /> PU�IC WORKS PERMIT PueucWorxeFea <br /> To�nifae s <br /> � Lesn AOt��Fen t�niU s <br /> � g g oae,��o o�o S 54� <br /> Print or Type Only� <br /> � <br /> � ww <br /> o� � <br /> "' P1 . W_ . — <br /> Owner ` � � � Mailing Addiess ity 2ip Phone <br /> a� <br /> ' GSf� n� � �* , pf3 t ZO� t U,TO!1._I,yAI1ypQC1y�'l.8 9Rn97 459_�514 i <br /> Applicant Madmg Address � ClY 2iP Phone � <br /> I <br /> pe5cn6cProPosedWor4 fi17 A nraA> anPr.py,j,�p3.�ey3/ �SQ_�,rdc nf comnactak�l_e f111. <br /> - W <br /> ProlectAAdressplknown) �� -'—arP�y �Qnn m• hor w; ii nrave _ � <br /> Attach lour(4)copies o� pla�s for Groposed work� Draw to scale antl nole ihe following as applicable: � <br /> � Property Lines • Centerline ol slreet � <br /> • Outline and dimensions ol all exisling and • Indica�e North <br /> proposed siruclures on Ihe lot • Show nny proposed grading changes <br /> • Ezisting a�d proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O , <br /> PERMIT CONDITIONS <br /> t.All calls tor inspection shall be made 24 h�s.in advance•phone 259•8810. � <br /> 2.All work shall be perlormed in accordance with this permit and current City ol Everett Design and Const�uction <br /> Standerds and Specilications. <br /> 3.Call Localion U�derground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> O <br /> � <br /> � <br /> O I <br /> � <br /> a � <br /> � <br /> , <br /> _`IA/ ACKNOWLEDGEMENT OP CONDITIONS <br /> �(CL�[//`l The under.,igned owner/applicant hereUy a9rees to hold and save harm- <br /> —v <br /> less the City ol Everett irom any and all claims lor Aamages, costs, <br /> expenses, or causes of ac�ion Ihal may arise because ol installation <br /> � � �� 1 _ �L_ �1 and moiNenance ol Ihe i9 provement or other right�obway usc hereto <br /> applieA br and furlher a rees to remove same upon notice Irom the <br /> Approved 1 onslrucU �/ // i ��« City and t` place pu ic ro ert �maycd Ihere2 j2 Z�g� <br /> � [�A� _ �///Q� �L_ � t.J� <br /> FINAL N ECTION � Date Dale <br /> Approved as Constructed Signature Applicact <br /> WORK A THURIZED BY TIiIS f'ERMIT MUST BE STARTED WITHIN <br /> evere[t PUBLICWORKSDEPARTMENT �g0 DAYS OF DATE P[Rh11T IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGEMi1' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA98201 CANGELLED BV THE CITY UPON ANY STOPPAGfl OF WORK ON THIS <br /> Phone:259�8610 PFOJECT OVER 90 DAYS DURAT101. <br />