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Date��� �,,�,��wo,..�,•,pm p�. �7 (y <br /> APPIiWtiOn For amn Or.pi.. _D_/,P.�.�S.I . - <br /> PUBLIC WORKS P�RMIT °„°'�°W°„��°° <br /> ,��.���� s- <br /> tessnnoi �e�r•a��i S <br /> oaie�n.000 S <br /> Print or Type Only — <br /> C' L... 1N���An�aNG I �' ap�C I n 91 /�e llnvu P �'cf'lz'4 — - <br /> OH,�e� Madm9 Adtlre55 Gly 7.ip PhOne <br /> ���[�dl f- l0�'-1 ,(�_ro2�m P!2 v�'�_.�1t1Q�--_ZZ�dG 3�. <br /> pp caM tdadmc�Address City ZiP Phone <br /> Descnbe Piouosrd Work PP'�L •AUA�I�y_"f-11��1C�=��d�' �'��1P�/ - <br /> _-- W <br /> Prolect AdAress 1�1 known� � <br /> Attach lour(41 copies ol plans for proposed worh.� Drnw Io scale antl note Ihe loilowinc�as applicable: � <br /> • Properry Lines • Centerllne ol sireet � <br /> • Outlme and dimensions ol all eMisting and • Indicate North <br /> proposetl structures on the lot • Show any pwposed grading changes <br /> • Ek�sling and proposed utilAies • Show measuremenls � <br /> DO NOT WRITE BEI.OW THIS LINE O � <br /> PERMIT CONDITIONS i <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shall be peMormed in accordance with this permi;and current City ol Ever=!;Desiyu and Construction i <br /> Standards and Speci�icaiions � <br /> 3.Call Location Underground Service 48 hrs.be�ore you dig.TOLL FREE NUMBER 1•800-424•5555. � � <br /> / O 1 <br /> 7 � ��- e"�ll.:<���.-Zi^/ •.��`:�.1 '11C�� <br /> ���l.C CGC � ��� /� / � <br /> �L �07t.1r1tc:t7%�'>•- �(� ��):G2d-Cv /4'/Q<�:c./�� (Vr7`l' ' � � <br /> � ,. ���`,�,8 N , <br /> G-3� Q ; <br /> � �(/�� �7��cz� ��:% SI�I, !'.�/ � <br /> //c-C�'�L``'"i� (� � �� .� ,��.47i! <br /> , <br /> ' �cS -1-'H• /�� � �_<<, <br /> ��.-�,.:,2 . � <br /> '//y ACKNOWLEDGEMENT OF CONDITIONS <br /> f'��C�c.Jc��..,r�/ / <br /> The undersigned ownei/applicant hereby agrees to hold and sa� �arm- <br /> less the Clly ol Everetl Irom any and all claims lor damages, .:osis. <br /> expenses. or causes ol action ihat may arise 6ecause ot installation <br /> and mairlenance ol the improvement or Mher nght�obway use hereto <br /> applied lor and lurther ac��ees to remove same upon nolice Irom the <br /> Approved lor Consiruction Date Clty ai�d to�eplace public properiy damaged ihereby. <br /> FINAL INSF'ECTION ���� Date <br /> Approved as Constructed Sic�nalure ol ApPlicant <br /> WURK AUTIiORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLICWORI<SDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREP.FTER IS TO <br /> � 3200Cedar Street BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett.WA 99201 CANCELLED BY THE CIT7 UPON ANY STOPP4GE OF WORK ON THIS <br /> Phone�259�8810 PROJECT OV[R 90 DAVS CURATION. <br />