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i <br /> � <br /> _ __. _ � <br /> Date�_T 89�,58 � <br /> c�.� P„�,�„wo,�,�,��„�,c�/�,c�.�..� /'Y��/�'� <br /> Applicatien For e�n�� o�n��+__�1_tOSDS_Ll_.S_) - <br /> PUBLIC WCRKS PERIUIIT �,��;o,wF�sF�,� §_------- ---_ <br /> LessAno� FnrPaN S <br /> o,m„«o�� S �DU� <br /> Print or Type Onl� _ <br /> -� l�ro�1�f-�"'_ ��n �I�1� 'L t�' - `���� �a7� ' <br /> Owrer a�hng Address City 7_ip Phone '� <br /> L� ll i <br /> Applicant Mailing Address Cdy Zip �phone � <br /> Descnbe Proposed Work ��YC _ _ __ <br /> Proiect Address lif known) �� `=�C� � -iC-������ •.S11�- � <br /> � <br /> Attach four(41 copies of plans for proposed work- Draw to scale antl note the lollowing as apPlicable: � <br /> • Property Lines • CenterGne ol street � <br /> • Outline and dimensions of all exis�mg and • Indlcate North <br /> proposetl sVUCWres on tta :�� ! Show any proposed grading changes <br /> • Exisdng and proposed util�ues • Show measurements � <br /> DO NOT WR�TE BELOW THIS LINE <br /> PERMIT.;ON^ITIONS O I <br /> 1.AI�,;alls for inspection shall be made 24 hrs.in advance-ohone 2�3-8810. � I <br /> 7.All work shall be performed in accordance viith this permit and wrrent City ot Everett Design and Gonstruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TI�LL FREE NUMBER 1•800•424-5555. � <br /> i ' <br /> T. !c� :��� cJ� 7na.�..� -a��:lG 6z ��.f�-. �-:,l -�i �cd .Pra` O I <br /> �� �/t,� _.u/uf� Qe�a,�G',..,.,<� ��- �ii�. d�ix.f�� �x/��a�. <br /> � <br /> � <br /> O <br /> a <br /> ACKfJOWLEDGE�dENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm� <br /> - !ess the Ci�y ol Everett Irom any and all claims �or damages. cos�s, <br /> ,_ � �� � � �"=-� expe s, or causes ol action ihat may arise because of installation <br /> . /' i . � and ai tenance ol the improvement or other right-of-way use hereto <br /> " appli.d r and furiher agrees to remove same �pon notice from the <br /> Ap Aved for Cons ction Dafe City nd to replace public property dama ed thereby. <br /> C�� _ w �� �� �� � <br /> FINAL INSP TION Date `� ' <br /> Approved as Conshucted Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY �fHIS i'ERMI? MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND TI;EREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BF <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br /> I <br />