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✓ <br /> Date��`°I P„i�i��wo,hs r�,m(((i'''���.yyy���/ �4`�'I <br /> A�pIiCB�IOn FOf �ItlO Deol.. _�J_��V��-_-- <br /> / <br /> PUBLIC WOF�KS PERMIT P��°��°��°��sF�° — <br /> ,o,a,F�� s_ _ <br /> Lc55AOPl f'r,ePaitl S — <br /> '7,C�`C�`� <br /> Bninm:e Gun $�_, _ <br /> Print or Type Only — <br /> �. rr, �d�� I�,,,w i ..Zu e ��� n-r� M�/1lrP e�l��yl i�i,�,�,E, �oiz � ys-r�a 3� <br /> Owne� Mailing Atldress City Lp Phone <br /> A�ipli� MadingAddress City L� Phone <br /> Des.:ribe Proposed Work � / S/ 11l1����.:/, /v ���l A �pT � /��1��('r�U.�L <br /> �T <br /> Pr,�ecl Ac:drE;s(il known) J Z�'1 � S1�_�_�U� la!_ � <br /> � <br /> Atlach fo:u(41 ron�e . ��1 plans lor proposed work � Draw to scale and note the lollowing as apPlicable: �� �'�, <br /> • Proper!v Lines • Centerline of slreet �A � <br /> • �utline and dimensions ol all exisfing and • Indicate Norih V) � <br /> proposed s�ructures on Ihe lot • Shew any proposed grading changes ��� <br /> • Existing and oroposed utilities • Show measuremenis � ,I <br /> DO NOT WRITE BELOW THIS LWE '� <br /> PERMITCONDIiIONS � I�, <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•SE10. sa� <br /> 2.A;I work shall be peAormed in acwrdance with ihis permit and current City of Everett Design and Consiruction ;' <br /> Standards and Specifications. <br /> 3.Call Locatioi� Underground Service 48 hrs.before you dig.TOLL FREE NUMBSR 1-800•424-5555. � � <br /> � <br /> � <br /> � <br /> \/ <br /> � <br /> �CKfJONLC-DGE�1ENT OF GONDITIONS <br /> The untlersigned owner/applicant hereby agrees to hotd and save harm- <br /> less �he City of Evere�t Irom any and all claims (o� damages, cos�s, <br /> � expenses, or causes ol action Ihat may arise because of installation <br /> � �`�� �'n��,/��_ �/_ /�_--�r-( and maintenance of the improvement or other right-of-way use here�o <br /> applieA for and further agrees to remove same upon notiCe from ihe <br /> Approved (or Con�s�tr�yctioi / Date City and to replace public property damaged thereby. <br /> f-% <br /> �%.� �- ///�� %��// / <br /> � <br /> FINAL INSPECTION Date '�� " �—— - -- ���� ���' { <br /> ApprOved as Constructed �"SignaWre of Applicant Date <br /> everelt PUBLICVlORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BF STARTED WITHIN <br /> � 3200CedarStreel 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DiLIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8870 GAN•^,ELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />