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89- yf � <br /> Date _ c�oi�cwo�ksvo,m��. -� <br /> �-.3d'8/ ApplicationFor Bitlg.Deo�.+ _ <br /> PI�BLIC WO�KS PERlIAI�' PbTotTFerFco � - <br /> Less Aoo�.Fee Paitl $ <br /> Print or Type Only !alnnce Due S <br /> � <br /> L/'o.r6 /�osn�s i%G� Mi� rcF.NB�vd /L/i(1C'i' •.E 990/c.' 75�5 - OZ32 <br /> Owne !Aao.�g Address Cit <br /> Y ZiP Phone <br /> •'1�G.F �io'U'�i/ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed N�ork _ /v CC�1 �.i/:/C', <br /> Projec�Addresslifknown) 's� �� ` /S`h/i✓P. Cc.J. � <br /> A!tach low(4) copies of plans br proUosed work- Draw to scale and note ihe following as applicable: � <br /> Y P�operty Line: • Cenierline ol stree� � <br /> • Outline and diniensions of all existing and • Indicate North <br /> prcposed sirur,tures on the lot • Show any proposed c�rading char.ges <br /> • Existing and proposed utilities • St�ow measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance� phone 259-8810. �� <br /> 2.All work shall be pedormed in accordance with this permd and current Cily ct Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> O <br /> y� <br /> � <br /> �p <br /> !f� <br /> ACKNOWLEDGEMENT OF CONDITIOtJS <br /> __ The undersiyned owner/applicant hereby agrees to hold anC save harm- <br /> less the City �f Everetl irom any and all claims for damages, costs, <br /> expenses, or causes of action thal may arise because of installation <br /> r '��� ///6_�D and maintenance of the improvement or other righl-of-way use hereto <br /> � applied fer and furtl�er agrees �o remnve same upon r.otice Irom ihe <br /> Appro d lor Constr ction Uate City and to �eplace public preperty damnged �hereby. <br /> rL_ G-��j�--- /�J- S"-5'U <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Siynalure of Apphcant Date <br /> eve:ett PUBUCWURKSDEPARTAfENT WORK AUTHORIZED f7Y THIS PERIv11T MUST BE STAFiTED WITHIN <br /> 3200CedarStreet 180 DAl'S OF �AT= PERMIT IS �SSUED AND THEREA�TER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PUASUED TO COMPLETION. THIS PERMIT MAY BG <br /> S � Fhone:253�8810 CANCELLED BY THE CRY UPON ANY STOPPAGE OF WORIC ON THIS <br /> PROJFCT OVER 90 DAYS DURATION. <br />