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�ate_`=�-l`-s�') 87— �92 <br /> PupIIr.SYarks�ormll x <br /> Application For 0� y.p��� q S'— <br /> PUBLIC WORI(� PERMIT �� � � i���=L <br /> n�er,c wo�xs r�� <br /> To�al Fee S <br /> Less Appl.Fee Paitl S �O C-��_ <br /> Prini or Type Only e����«o�a s <br /> ;; , ;r���►�,��'�I ���'� l-�� �^ ��-�1-��� I�v-F9�IY1 ? �18t--1GY� <br /> Owner Mailing Address <br /> Cily Lp Phone <br /> a.t,V'Y�. <br /> ApplicaM Mailinc�Address City 2i <br /> P Phone <br /> Describe Proposed Work II tt�.�-C.l �2 {�^"��-'���I�1J17�l�l�r . <br /> { <br /> - -r����6�r <br /> /2..3C�� - '-�' 6�i <br /> Project Address�if known) � �� L�f?. �"�e� � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines �e <br /> • Outline a�id dimensions of all existin and � � Centerline of street I_ � <br /> y • Indicate North ��7 <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities O Show measureme^.ts <br /> DO NOT VJRITE BELO`.N THIS LINE � <br /> PEqMIT CONDITIONS � <br /> t. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction � ' <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. �efore you dig. TOLL FqEE NUMBER 1•$00-424•5555. <br /> ,�.t/�/ �,r'T�'�/S:lir= ��! C�•i/ /pi Gt/i�C i�_< �_ � : <br /> � C�c.ii. � � <br /> �(JJ�!_iG Gc�Oi?�C'S lJ�=_..�'ri�:TA)E�T ��i'J/��/�y�G, I <br /> I <br /> � ' <br /> w fI <br /> '�/ I <br /> � i <br /> � I <br /> ACKNOI^JLEDGEl�1ENT OF COfJDITIONS <br /> _ The undersi�ned owner/z�pplicant hereby agrees to hold and save harm- <br /> � less the City cl Everelt Irom any and all claims for damages, cosis, <br /> � j � expenaes, or causes of action that may arise because ol installation <br /> 2��jp�Z � 2��7 and maintenance of Ihe improvement or other righ!-of-way use nereto <br /> Approved lor Constr,fcuon � /pa�e applied lor and furiher ac�rees to remove same upon notice from tha <br /> City and to replace public proper)y damaged thereby. <br /> > C.�U U� � . �, � /// <br /> � � <br /> rINALINSPECTION �/ Da�e � �/./-�/� 1 n yc/ <br /> ApprovedasConstructed � � —� `-�-�. '!�� � '�-C�-� / ��_� <br /> � Sigpature of Applicant ' � ate <br /> everett PUBLIC WORKS DEFAFTMEPlT WORK AUTNORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 7� <br /> F.erett vv..982U1 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> r ROJECT OVFR 90 DAYS DURATION. <br />