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� ; ' '. ; . ,� --�,_ ._ . ."_ ' ' ___ ` _ _ " __ — _.�."." __� ..25„ ' . .:'-.,M� �, �,:,T��.',.�.•ir�`'.5 <br /> 8�Z 3�� �� �, <br /> �8�e \ � , PUEI¢WorMs Permn t <br /> Applicatlon For ' eiay.oep�.+ 90/25�5� <br /> PUBLIC WORKS PERMIT Pu07olaIF�Fee s <br /> Lean�00�Fee Paitl S <br /> Print or Type Only B��a�=Bo�� s <br /> Tos Rubatlno 4919 - 23sQ Jln N Evar�tt 98203 ]51-9739 <br /> Owner MaiNng Address City Zip Phone � <br /> Olm�r <br /> Applicant Ma�ling Address City Zip Phone <br /> 1 <br /> Describe Proposed Work MditiAa to 8!R <br /> Project Add�ess(It known� 4919 — 23sd 11w N <br /> W x <br /> Attacb tour(4)copies of plans for proposed work- Draw to scale and note the following as applicabie: � .:� <br /> • Property Lines • Centerline of street - � <br /> � • Outline end dimensions of all exiating and • Indicate Nwth <br /> proposad structures on the lot • Show any proposed grading changes <br /> � • Existing and propoaed utllities • Show measwements � <br /> DO NOT WRITE BELOW THIS LINE � O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inapection shall be made 24 hra in advance•phone 259•881 Cl � <br /> 2.All work ahall be peAormed In eccordance with this permit and current City of Everett Design and Conatructlon <br /> Stendarde end Specifications. <br /> � ' 3.Cell Locatlon Underground Service 48 hra before you dig.TOLL FREE NUMBER 1-800-4245555. � <br /> / - /% O <br /> ��t(�.�c LcJa7r-.: �Z:: _,,. f ����'�rr�x : f - <br /> ����;c` �-�' � <br /> 6'- �Y-7o <br /> � IO tf <br /> � �n <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undarsinned owner/a?plicant hereby agrees fo Rold 8Rtl save herm� <br /> less the Ciiy of Evere�t from any and all cleims (o� damages, costa <br /> expenses, or causes of action thai may arise because of installation <br /> and maintenance of the improvement or other right-of•way use hereto <br /> applied for ard further agrees to remove same upon notice irom ihe <br /> � Approved for Construction Date City and to replace public proparty damaged thereby. <br /> fINAL INSPECTION Date <br /> Approved es Consiructed Signature uf Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA9B201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE � <br /> Phone:259-8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS . <br /> PROJECT OVER 90 DAYS DURATION. <br /> i <br />