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�" g-�s -s <br /> Date �-/• �� PublicWo�kePe�mO• 88—.�3Z <br /> Application For Bi,1g Depl • <br /> PUBLIC WORKS PERMIT Pu�licWorkeFee <br /> T�tal Fee s <br /> La55 ApPI.Fee PeIJ S <br /> Print or Type Only Balancu Dua s� <br /> �-f� �oNsrQurfiorv �325 GISrA-ue. N �C. I�cre� �1, G��15�205 �'3�6�i7 <br /> Owner Mailing Address City Zip Phone <br /> �8—�n.v�� o--� �—G�-o--«� <br /> � Applicant Mailing Address City Zip Phone <br />� Describe Proposed Work 7�� , �`"�"� ✓�n2��1--� (�C-C G�L-C� , l�-/ �[.l�L��e-/"'`��^' <br /> 1 <br /> Prolect Address(if known) �yd�' ��"�""�' � <br /> � <br />�� Atlach foc��dl copies of plans for proposed work• Draw to scale antl nole the lollowing as aoplicable: � <br />. • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br />�j • Existiny and proposed utilities • Show measurements � <br /> I DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br />� 1.All calls lor Inspectlon shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be pertormed in accordance with this permit and current City of Everett Design and Construction <br />� Stendards and Specifications. <br />� 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> C <br />� O <br /> � ' <br /> � ' <br /> O <br /> OS/IB/BB 9�12AM OOORti2031 �T <br /> / li <br /> N00013168 ' <br /> DPT.2D t20.00 <br /> ACKNOWLEDGEMCENTOF�N DI�TIONS � <br /> Q The undersigned owner/applicant hereby agrees to hold and save hann- <br /> less Ihe City ol Everett twm any and all claims for damages, costa <br /> / - '�� �jQ�B expenses, or causes ol aclion that may arise because of installation <br /> D 2�I 0 and maintenance ot the improvement or other righPol-way use hereto <br /> Appro lor Construc ion � � applied for and further agrees to remove same upon notice irom the <br /> City an to replace pub6c erty damaged thereby. <br /> �� T�oN � 6 �J' �J�`_ 8'-/5-� _ <br /> Approved as Constructed Bignature of Appli nt Date <br /> everett PUBLICWOFKSDEPARTMENT WORK AUiHORI ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 32GOCedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMiT MAY BE <br /> Phone:259�^"'0 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIf <br /> PROJECT OVER 90 DAYS DURATION. <br />