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Date�.[�/ runer wnns rn�nn . _ — <br /> / ' " " nina o�ni . �����-- <br /> Applicahon For � <br /> PUBUC WORKS PERMIT PuhTa�ifneF^^ : <br /> Lxfe Appl Poe Peia S <br /> qxiani n fluw S <br /> Print or Type Only <br /> r�� �� J1CtJ L ✓P/P �' ��`� <br /> �Owner��� � 7 —/�Maihng Addresa City Lp Phone <br /> C � Zip Phone <br /> Applicant Meiling Address City <br /> Desc�ibe Proposed Work N-!Ai/IidG f P1_.��(S — <br /> � <br /> _ th � <br /> Prolecl Addraes lil known) <br /> Aflach lour(4) copies ol plans lor proposed work- Drew lo scele and note Ihe following as appliceble: � <br /> � Property Unes • Centerline ol sireet � <br /> • Oullfne and dimensions ol ell e�iating end � Indicate North <br /> proposad slructures on ihe lo� � �how any proposed grading chenges <br /> • E�Isting end proposed ulilitiea • Show meesuraments � <br /> DO NOT WRITE BELOW THIS LINE O <br /> ' PERMITCONDITIONS <br /> 1, All cells for Inapection shall 6e mede 24 his. In edvence- phone 259•881 5. � <br /> 2. All work ahell 6e performed in accordence with thls permit end current City of Everel�Deslgn end Construction <br /> Standerds end Specilicatlons. <br /> 3. Cell Locallon Underground Servlce 48 his.balora you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �iJd[.iL ccJc��'K�' /�c'�cr»•T.t/cz- .�'EC�'U�c'LO �-�c'-d7 O <br /> `���_r' <br /> � <br /> � <br /> O <br /> � <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> The undersigned owner/epplicent hereby eBrees lo hold end seve hnrm- <br /> less �he City ol Everett from eny end all clelms for damayes, costs. <br /> expenses, or causes ol action �hal may erise becausa uf inslallation <br /> and mnintenance of the improvemenl or other ri�hbof-way use hereto <br /> npplied lor and luriher agrees lo remove snme upon nolir.e Irom Ihe <br /> qpproved lor Co�etruC�ion DBIB I Ci�y�nA b repl�ce pubhc proPerty damayeA �hPrehy. <br /> FINAL INSPECTION Date — p2�z <br /> Approved es Gonslructed SiqnaWre ol Applican� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTf:D WITHIN <br /> rvrrett PUBLIC WORKS DEPARTMENT 180 DAVS OF D4TE PERMIT IS ISSUED AND THERLAFTEP IS TO <br /> � 3200 Ced+v Street BE DILIGENTIV PUt7SUE0 TO COMPLETION. THIS PERMIi MAV BE <br /> Eve�etl, WA 9P201 CANCELLED BY THE CIl V UPON ANY STOPPAGE OF WORK QN THIS <br /> Phone� 259�8815 PROJECT OVER 90 DAVS DURA710N <br />