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Uate�J�7 9 ' r, Pubi¢Woas Ve�mn• <br /> ` /�3 y3_� <br /> Ano��catien For emc oe�� .___�R�.. <br /> PUBLIC iNORKS PERMIT P°°°°w°°°��° ---- <br /> TOIPI�PP, s <br /> LeS�4p0� �!e PaN S <br /> Print c:r Type Only e.m��.o�� S _ <br /> Lrs�ytM PDt)PC d- S?"nr� �d��r�. �r��j�� I PHJp(' <br /> O�.roer Mailing A ress Ctly Zip Fhone <br /> �orr�� Qr�o�C�la /�Pcrnv� ,PilJl�] �✓Q�P-f� ��L�.��:i�—,�?� <br /> audliCant Mailm9 Addre;s Gty Lp Pfione <br /> DescribcProposedWork �(���new � �Q(�i� � P� '[Y+_ ���A <br /> ___�— <br /> Pro�eclAddressldknownl �3�� la��..�-��Q_ � <br /> � <br /> A;tach lour 1�1 copies of plans for proposr.d work� Oraw to scale and note Ihe lollowinc�as apPlicable: � <br /> • Properly Lines • Centerlme ol street � <br /> • Outline and dimensions ot all existing and • Indicate Norfh <br /> proposed structurr.s on the lot • Show any proposed gratling changes <br /> • Eaistmg and pr000sed uti6ties • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LIN[ <br /> PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAamed in accordance with this permit and current City ol Everett Design and Construction <br /> Standerds and Specifications. <br /> 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��8��-c'��L'`�'z.�.n�� _ � <br /> ,,.- / /7G C^<y�' � <br /> ^� � <br /> O <br /> a <br /> ACKNOWLfOGLM[NT Of CONDITIONS <br /> The undersigned owner/app�i ant hereby agrees to hold and save harm� <br /> --- -- — Iess !he Cily ol Everett Irom any and all claims lor damages, cosis. <br /> expenses, or causes ol ac�iun ihat may arise because ol installation <br /> : nd maintenance ot the improvemenl or olher right•ol�way use hereto <br /> .�pplied lor and lurther agrees lo iemove same upon nolice Irom the <br /> Approved lor Constru�.�ion Date City and to replace pubhc property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Apphcant Date <br /> ereretl PUBUCWORKSDEPARTMENT WOPK AUTHORIZED BY THIS PERMIT IdUSI BE START[D WITHIN <br /> � 3200Cedar5lreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER iS TO <br /> Ecre�t,WA98201 8E DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�88t0 CANCELLED BY fHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER QO DAYS DURATION. <br />