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�,s� i ) <br /> Date —ZZ—P,-r 71/ � 7 PuDLc Worwa Permit• �� � <br /> T' ��1 L,�� BiEB.DePi.• <br /> Application For <br /> PUBLIC WORKS PERMIT . `°°"""°`""`° �� — <br /> iolnlFee s <br /> �/y Le56 ApD�F<e PeiO S� <br /> � �� <br /> 8alence Due S <br /> Print or Type Only <br /> Pt�tlLr b� �lc�C vCs C�O6 33 ,,� S{ �vt�re� �i,fr l�za/ Zs'` -/076 <br /> Owner Mailing Address C�IY Zip Phone <br /> ����; Gcv� l'oG 33'� � Evr.te7/ � 9F�J/ �Y1- �oJ6 <br /> Applicant Mailing Address City Zip Phone <br /> � � S�, � <br /> Describe Prop se=Work ^ <br /> �7 <br /> //,� � w y �a/���/—,C'uci:E'� � y ro <br /> Project Address(il known) � G ` �'tuPA <br /> � M �Altach tour(4)copies of plans for proposed work-Draw to scale and notc the lollowing as apPLcable: � � <br /> • Properry Lines • Centerline of street � <br /> • Ou�line and dimensions of al�existing and • Indicate North � <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis M � <br /> DO NOT WRITE BELOW THIS LINE O � <br /> � H <br /> PERMIT CONDITIONS z <br /> i. All calls tor inspeclion shall be made 24 hrs. in advance-phone 259•88�5. � � <br /> 2. All work shall be perlormed in accordance with lhis permit and curren;City of Eve�elt Design and Construction y �„i <br /> Standards and Specilicalions. K N <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOIL FREE NUMBER 1•g00•424•5555. � O � <br /> ��Lp�Nt A.cIT �lA�'el LI4�t-� dti-t �7t� E�5 O � H <br /> G+� �Clhf�'a�A(I-t�T (�1�41-�t� lK �d-L� � � <br /> � �l�xt-��c�,r-�. � � o� '`�c��u.�Ac�� �� � <br /> ax N � <br /> � ��5 <br /> a � <br /> � <br /> � <br /> � <br /> ACKNOWLEDG[MENT OF CONDITIONS � <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� n <br /> less the City of Everett Irom any and all claims lor damages, costs, �,� <br /> enpenses, or causes ol actio�. that raay arise because of installation <br /> � �� � ,� d maintenance ol the improveme��t or other righ4ol-way use hereto <br /> applied lor and furiher ag�ets lo remov same upon no!ice Irom the <br /> �pproved for Conslrudion a�e City and to replace public property da g 1 rebY. <br /> ���G/ <br /> r �' -�a- � ks <br /> AL INSPECTION ��1e ale <br /> Approved as Constructed . S 9naWre ol APPlicanl <br /> PU�LIC WORKS DEPARTMENT WORK AUTIiORIZED BY T IS PERMIT MUST BE STARiED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELL[D BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�8315 pROJ[CT OVER 90 DAYS DURATION. <br />