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Date.�J -// s�aV i,,n�.�.vm�..sv,.p,mp�i• -�-7-- /� - <br /> ��/� Bing Deoi � ..6-I-�[.C�3J�__ <br /> AnPlication For <br /> PUBLIC WORKS PERMIT �'��°���w°��°`�-� - _ <br /> .��a��e� 5- <br /> �,.,,.�::, ��..��.,., s <br /> ��,., „�, , a <br /> Prin� orType Only — — <br /> ��c �ln� drzkru��xc� Lur��_jl���_�!{ ,✓P S�L����� <br /> Owner IvlaiNny Aatliess i�y 7_ip Phonr, <br /> Applitant Mailing Address City Zip Phone <br /> ,/ (� CY�ur/'� / //_ <br /> Descnbe Proposed l'Vork . �P "nu� � .Mf1G�✓1�1n-(� - ���AO Y-,/�� T r!-Y <br /> !] � �/ � <br /> Prolect Adtlress GI knownl 7y�Ld Nif�f,QJi_/�?LP_ Su�/'0 µ��-- � <br /> Attach lour I41 copies ol plans lor proposed work- Orav.�lo sr.aie antl note the following as applicabie. � <br /> • Property Lmes • Cente-line ol street � <br /> • Outline and dimensions ol all enistmg and • Indicate Norih <br /> proPosed st�uctures on the lot • Show any proposed grading changes <br /> • Exic'iny and proposed utdities • Shoc+measuremenis M <br /> W <br /> DO NOT WRITE BElO1N THIS LINE O <br /> PEflMIT GONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•88�0. � <br /> 2.All work shall be performed in accordance with this permil and current City ot Eve�ett Design and Construclion <br /> Standards and Specificafions. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> /�/�` � - ' O <br /> �� <br /> � � -s -89 N <br /> O <br /> a <br /> ACKNOWLEDGEM[NT OP CONDITIONS <br /> The undersiyned owner/apPlicani hereby anrees to hold and save harm- <br /> less ihe Cdy of Everetl from any and all daims for damages. costs, <br /> expensrs. or �auses of adion that may anse bec2use of installation <br /> and mamtr.nance of ihe improvemen� oi olher nghPol�way use here�o <br /> apphcA lor and luither agrees Io remove samc upun no�ice iwm �he <br /> ApP���ed�or Conslruciion Dale City and to rePlace puli�i.:Pronerty damaqed �hereby. <br /> FINAL INS('ECTION Datc <br /> Approved as Construcled S�y��aturrs ol Apphcant Dale <br /> VJORK AUTHORIZED BY THIS PERMIT IdUST BE STARTED WITHIN <br /> everelt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND ?HEREAFTER IS TO <br /> � 3200 Cedar Slreet ,c DIL�G[NTLY PURSUED TO COIdPLETION. TNIS PERMIT MAY BE <br /> Everett.R'A 98201 CANC6LL[D BY THE CITY UPON ANY STOPPAGE CP WORK ON THIS <br /> Phone:259�8810 I PROJECT OVER 90 DAYS DURATION <br />