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y -_. _.,,.. <br /> .� <br /> Date�1 PuOLc Wo�ke Pe�mii♦ �_�`�� / <br /> ApplicationForTO POSTING 2"3� �-43 e�°9.°°0,.• �— <br /> PUBLIC WORKS PERMIT PuOTo�FeeFee ` -- <br /> Lasa Aoa�.Fea Paia 6 . <br /> �- <br /> Print or Type Only Be�e�=a o�a s� -- <br /> /� )P`FQrn MPS � ��0�7-7�hf��, SY_ Ln,�eS�edPns F�o2.S13' 33�f-/�I�f� <br /> . Owner MaiVing Address City 2ip Phone <br /> � Applicant Mailing Address City Zip Phone � <br /> UaacribeProposedWork �1p�lA� ����P �M[���f��P2��'Q- �. <br /> _ Ldf .� � g.v. �-�a�- �9� Blo�� ,i�l�ce�/T _ <br /> ; <br /> � �/ W ' <br /> � HProjact Atldress(it known) ��'3O � Z7 � �'P `r'E' , <br />�• - �� Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> I s'��'� • Property Lines • Centerline of street � <br /> � • Outline end dimensions of all existing and • Indicate North � <br /> i , proposed structures on ihe lot • Show any proposed grading changes <br />( ���� , • Ezisting and proposed utilities • Show measurements � � . <br /> DO NUT WRITE BELOW THIS LINE � <br /> �II . I O <br />�`%�- ' PERMIT CONDITIONS <br /> i�;:�(�� ' 1.All celle for Inapectlon ahall be made 24 hrs.in advance-phone 259$810. � � <br />� �� ' 2.All work ahall ba pedormed In accordance with this permft end curcent City ot Everett Desfgn end Constructian <br />� � � Standerds and Speclficetlona <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�4245555. � <br /> C�-�.�.�.��.. � y� � � d�,.� ,�. � <br /> �'r5�f ,p.l<..t` �¢�uvu.«.`„� , � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDI110NS <br /> The undersigned owner/app'�icant Yrsreby agrees to ho!d anA save harm- <br /> less thr. City o( Everot: from anY and all ciaim� for damages, costs, <br /> , � expenses, or causes uf ar.tion that may �+iae because of installation . <br /> �� �J 7 �9—�_� and maintenance of Ihe impro�ament or�.riher righ4ol•way use herero <br /> �� applied fo� and furiher agree� to remove seme upon notica trom the <br /> � Approve � r Consif ction Date City and o�reCdece public property d maged thereby. <br /> �� j ,�. <br /> NAL INSPECTION Date � <br /> Approved as Constructed Si na e of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet4 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />