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Date�� 93 '; . <br /> 7 �� PUEIic Work�Permit• <br /> AppliCeflOn For Bitlp.Dao�.• <br /> PUBLIC WORKS PFRMIT ^��To�F;F� s <br /> L���Aoo�Fae v�ia S <br /> Print or Type Only TIl QnSTl1,1/��=)��� e.u��.o�. s �✓D cJ/,9,e� <br /> IIV <br /> �.C�. �SAt.t►JG�s I602 �l�W�'rT��� �V�QETT �l �82a I z5q 4 5 73 <br /> Owner MaiHng Address City Zip Phone <br /> Go,.� � �n.�2s � n�/2�3► w�-r� �4v�, � �av/�v wa-9e2o_i e�-s�, <br /> Applicenl Mailing A d�ess CItY ZiP Phone <br /> Describa Proposed Work GO 'TI�c T �� �.{���/ � �p� EV���-C'T r�����ri�� <br /> f- <br /> Tu�x►rcR k�1t� ,ar� i,te�r.lT MG�c�i Q�� #�,�d1u,1.9G LOr �A�L <br /> O -- - T - <br /> Rcv u �cc+s. W <br /> Proiect Addrosa Iil knownl �lt� �,oc� . �� 41 �� f�� t�J� pN ����� � <br /> Attach lour(4)copies oi plana for propo�ed wor�lc LDrewrto sale�anQ nota the following as applicable: <br /> � <br /> • Property Lines � Centerline of street ' � <br /> • Outline and dimensions of all existing and • Indicete North � <br /> proposed structures on the lot • Show eny proposed predinq chenpes <br /> • Exlating and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS IINE <br /> - PERMIT CONDITIONS � O <br /> t.All calls for inspectlon ahall be mede 24 hra in advance•phone 259�8810. � <br /> 2.All work ehell be peAormed in axordance with thia permit end current City of Everett Desipn end Conatruction <br /> Standarcls end Specifications. <br /> 3.Call Location Underqround Service 4B hrs.before you dip.TOLL FREE NUMBER 1-80a424•5555. � <br /> `�. .Si�C LcJOr,f fd � �one �Atr PLq.�s APProveo� �3/ f'i.�rr7f O <br /> �tY�6LiG G:pr.(r or� ]�5-93 /cpy A77AcHEp� <br /> l' � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owne�/app�icent hereby agrees to hold end save herm- <br /> less the City of Everett Irom eny and all claima for damepea costa <br /> � ezpenses, or causes of action that may arise because ol installation <br /> /5- and maintenance of ihe improvement or other riphbof-way use hereto <br /> applied 1 r and funher agrees to remove same upon notice irom the <br /> App�ove or Cons io/) a�e City antl replace public property emeged thereby. <br /> ax-f� �,—� t � <br /> FINAL INSPECTION Dale r <br /> Approved as Constructed ignatur ol Applicant Dat <br /> PUBLIC WORKSOEPARTMENT WORK AUTHORIZED BY THIS PERMIT MU T BE STARTED WITHIN <br /> 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED A D THEREAFTER IS �TO <br /> Everett,WA88201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> P�one:259•8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />