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q �,��„��,c�o�k�r�,m�� a°J�`F3`I _ <br /> Date�� �L2s�'�.5.__ _ - <br /> r�iae D��oi.. �__ <br /> Applicalion For __ _____ <br /> PUBLIC WORKS PERMIT P��ImWorksFce <br /> To„���� S- <br /> LeesNnol Fnrenid 5 -- <br /> [$dllllfC�uC CJ�t� � - <br /> Print or Type Onl;� <br /> � (` �� /nill /P��9�a�z 7'�S�OL3Z <br /> � �n�c.L�,�,�,�_,�� ��—i�t.f' ° d �-r�r. . --- <br />� Ownc�r <br /> Mading Address C�ty Zip Phone <br /> Applicant <br /> Mailin9 Address City 2ip Phone <br /> Descnbe Proposed Work �.�I� ( 'i,�`�.L�1�cIC•.J rl� d LIJ, ��r�.l ��/1 <br /> � <br /> i � <br /> Proiect Address�if knownl —. <br /> ��Zt�S – l S r�' l��L 1�.� — <br /> �� <br /> Attach four(4) copies ol Plans for proposed work- Draw �o sr,ale and note ihe followiny as apU��ca61e: � <br /> • Property Lines • Centerline o1 sireet <br /> • Outline and dimensions ot all existing and • Indicate Norih <br /> proposed struGures on �he lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All c�lls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall 6e peAormed in accordance wilh this permit and current Cily of Everett Design and Construction <br /> Stan�ards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> 0 <br /> �w <br /> �/ <br /> � <br /> !�� <br /> AGKNOW!EDGEMf_NT OF CONDITIONS <br /> 7he undersigned ownedapplican�hereby agrees to hold and save harm- <br /> less ihe Ciry ol Everett Irom any and all claims for �amages, cosls. <br /> expenses, or causes of action that may arise because ot installation <br /> .��CC�Ill���EC- (/—��_��� and maintenance of the imp�ovement or c�her righbo4way use hereto <br /> applieA tor and further agrees lo remove same upon nolice irom the <br /> Approved for Co struc�ion Date City and to replace pubGc property damaged lhereby. <br /> �� <br /> li_I ���1�G � ' l�/l� � <br /> ,l�' � u � a.� <br /> FINAL INSPECTION Date pa�e <br /> Approved as Consiruc�ed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everMt PUBLICWORKSUEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet 8E DILIGENTLY P'JRSUED TC� GOMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 99201 CANCELLED BY THE CITY UPON AIJY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVEN 90 DAYS DURATION. <br />