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Date <br /> rJ/L(�ia Pnnl,c Wndx PermNe 9� Z38 - <br /> Application For OWL,dent. <br /> y PUBLIC WORKS PERMIT PuU1.ruler FxeFN � <br /> TMeI Fee <br /> Q <br /> TO POSTING Lex$AWL Fee Peid <br /> Heeunce bus 20 <br /> Print or Type Onlr <br /> H •�• ..r �T V'1 UUP nCJ 8 rJ � C- m <br /> y H '.q M M M M rNt M M <br /> Q xo /ru ar� Z., A N Ai /Hen S>p�A/u- IV6 992UZ 53�� <br /> Q yQ Owner m'` r r� T u11(T9�i90Qr �r�O C� '.i-. i] City / Zip Phone <br /> Y j � (u� T_ N (� F- f] ~a W <br /> :>_ � J L d m C] nt � SL 3 •-� � A"W <br /> O HM Applicant <br /> Applicant Mailing Address City Zip Phone <br /> WO / <br /> �` C7 Describe Proposed Work 0ea/ F"F151A ",IV ��t� —La }<' S/ �uNl_��n��✓ <br /> yZ H -_,J- <br /> r <br /> co y <br /> H <br /> d W <br /> C) y _ <br /> t M� Protect Address Ul known) �•3 �°�•r"�' PL•SE• <br /> til y 1 <br /> Tn Attach lour 141 copies of plane for proposed work•Draw to scale and note the following as apphcaDh. rr•� <br /> • Properly Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North v, <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed ollhlies • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS <br /> 1 1.All cells for inspection shall be made 24 hrsin advance•phone 259.8810 <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Con_truct.on <br /> Standards and Specifications. <br /> w 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.8(10.424.5555. z <br /> 0 <br /> laaaa0 <br /> 1. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages. costs. <br /> expenses, or causes of action that may arise because of installation <br /> p �' and maintenance o1 the improvement or other rigM•of-way use hereto <br /> [�uX 1"1 applied for and further agrees to remove same upon notice from the <br /> Approved for Cons lion DaleCI Lndoreplace public properly damaged thereby. <br /> FINAL INSPECTION Date 71 /q/ <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Ceder Street 180 DAYS DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY <br /> Y PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259.8810 PROJECT OVER 90 DAYS DURATION. <br />