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��o� F;7- 89 <br /> Date� � Pulil�c WaFe Pormit� B�— ��S <br /> .d� <br /> / uiao.oa�,i . _���� <br /> Applicntion For <br /> PUBLIC WORKS PERMIT P°°:aWF��`°a s <br /> less AOV�Foa PaiC S <br /> Balanco0ue �+ �2�� <br /> Print or Type Only <br /> i <br /> �dLL{�Y.�c�'145� J?p• i�nX Z(�Z 11�,��n rn P q,.�z �.Z 7Q�1—SSD� ���, <br /> Owner Mailing Address City Zip Phone � <br /> � <br /> Sq M e — � <br /> App�icant Meiling Address Cdy ZIp Phone ' <br /> i <br /> 1 I I r i <br /> Describe Proposetl Work __pS. .�7 —[�n ' � 7 nr T'� �T �.(/ � � /AC�S <br /> I <br /> b — W ' <br /> Pro}ect Address(it known) � , <br /> 4 Reo. ok .rv'.,�l7 i <br /> Atlech lour(4)copies ol plans for proDosed work• Draw to scale and note Ihe following as applicable: � ' <br /> • Property Lines • Centerline of sireet � � <br /> • Outline end Aimensions ot all Nzistiny antl • Indicata North � <br /> p�oposed structures on the lol • Show any proposed gradinq char7es <br /> • Existing end proposed utllities • Show measurements � , <br /> — DO NOT WRITE BELOW THIS LINE <br /> PERMIiCONDITIONS O {�, <br /> 1. All calls for inspeclion shall be ma7e 24 hrs.in advance- phone 259•8815. � i <br /> 2. Ail work shali be periormed in accoMance wilh this permit .ind curren�City ot Evere�t Design and Conslruction <br /> Ste�Cerds antl Specilicetions � <br /> 3. Call Lceation Underground Service 48 hrs.belore you dig.TOLI FREE NUMBER 1-800•424•5555. � �' <br /> �� WC��Cp �[G. O�O>cL /�.t'iZ Q�-O��L-[d'� ,Ll4-rv C/O�Led' ��" '�/g � O ; <br /> i <br /> � � <br /> � <br /> O 1 <br /> a <br /> AC�CNOWLEDG�MENT OF CON�ITIONS <br /> The undersiyned ownedappGcant hereby agrees to hold and savo harm- <br /> _ less the City of Everett 1rom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise 6ecause of installation <br /> �/Q� /✓ /D /�_ and maintenance ot the improvement or other righbol-way use hereto <br /> i'�07�f�" <br /> applied for und luriher agrees to remove same upon no�ice irom t e <br /> Approved br Construction Dale Ci�y and to re e blic property dama d ihe�eby. <br /> ��� ���%���1�%�'�/`- �o//S F 7 <br /> FINAL INSPEC Date � <br /> qpproved as Consiructed Sic�naWre ul Applicanl ate <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> Q 3200 Cedar S�reet BE DIL�GENTLY PURSUED TO GOMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPOtJ ANY STOPPAG[OF WORK ON THIS <br /> � Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />