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M <br /> ,` 2197 <br /> y PubLc a mit Works P • T <br /> Date aide DSP, 01 <br /> Application For <br /> PUBLIC WORKS PERMIT Pubecwdrer, <br /> cIN Fes <br /> Lees APPI Fee Paid S `� <br /> Belsace Due t{ — <br /> Print or Type Only 7Ps� <br /> z,N2breLj�R Co F15-- / 0(0 Zip . ysPhone <br /> so�yS� <br /> Owner Mailing Address <br /> Clly <br /> `) AptC CIt -- Zip Phone CD <br /> Y <br /> Applicant <br /> Meiling Address .~. <br /> r, <br /> Dnscrlbe Proposed Work i -�-�•'� <br /> 0 <br /> m <br /> c c <br /> M c <br /> /07 77 zv. �L S W. --- 1^ <br /> Protect Address(it known) <br /> m <br /> as a <br /> Attach four(4)copies of plans for proposed work- Draw to scale end note t e following of stPeot a e. <br /> • Property Linea <br /> • Indicate North p z <br /> •Outline and dimensions of all existing and • Show any proposed grading changes c <br /> proposed structures on the lot • Show measurements M > •-' <br /> • c_;;;s:i110 and proposed utilities iOD r 3. <br /> n <br /> DO NOT 1YRITE BELOW THIS LINE T <br /> PERMIT CONDITIONS —i rl <br /> nce- phone 259-8815 <br /> 1. All calls for Inspection shell be made 24 hra.in adva _ <br /> m — <br /> 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction N <br /> Standards and Specifications u r <br /> 3. Call Location Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•800-424.5555. <br /> nm <br /> c rn <br /> z n <br /> �m <br /> n <br /> z <br /> S• <br /> VA, <br /> a <br /> L rear <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> leas undersigned <br /> tyof Everett owner/applicantnom any and allclaimsor <br /> go hold <br /> theC damages, costs, <br /> expenses or causes of action that may arise because of Installation <br /> /O <br /> and mei tenence oft Improvement or other right-ol•way use hereto <br /> -„ — applied or end 1 h r agre s to remove same upon notice from the <br /> Dale Clly an to rept 6 u c p party damaged thereby. <br /> Approved for onslruction j <br /> ('!b'A1t,. tt� o a2 <br /> TIO Dete D le <br /> IN I Signal a of Applicant <br /> Ap r?ved es Co ruc WOR AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 14§1PU LIC WORKS DEPARTMENT 160 LAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 15 BE <br /> TO <br /> 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY <br /> Everett,WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259.8815 PROJECT OVER 90 DAYS DURATION <br />