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� � <br /> Date � �� Pu�l¢Worke Permn• <br /> ApplicationFor eieo�oem..9o�,i .7�_e <br /> PUBLIC WORKS PERMIT Pubi¢Wonve�ee <br /> Totel Fee s <br /> Le55 Ap01 ipp Pe�O S_, <br /> Print or Type Only ea�e^=e o�e S _ <br /> "/ d D L �Cd � <br /> Owner MaJingAddress C�ry Zip Phone <br /> A-C:. /�SSoC//1r"CtS <br /> -,�r-`�-�s- -=�� rr,��=n/ /�/ S I,�IEsrL�k.t- .BdC- .d sE'a.—r[E sF:c y � Fs=t�J Z <br /> Applicant Mailing Address City Zip Phone <br /> Deecribe Proposed Work ND X 7.f � A0� irie d TD �YiSTi,�/L ✓I!L/L/J/L l <br /> ProjeclAddress�ilknown) ���� r�u�����"v � <br /> � <br /> Attach lour(4)copies ol plans lor proposed work- Draw to scale and note the foilowing a.,applicable: � <br /> • P�operty Lines • Cenle�line of streel � <br /> • Outline and dimensions of all existing and • Indicate No�ih <br /> proposed struGures on ihe lot • Show any proposed grading changes <br /> • Eaisting and proposed ulilities • Shcw measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be madr.24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall�e perlormed in accordance wilh this permit and current City ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground&ervice 46 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> N� �� b (�C. �JOtZ.�S 1 �v� �� ���: re� O � <br /> -(���.�,v�� �� F" <br /> � <br /> �/► � /�o p <br /> a <br /> ACKNOVJLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less tha Cdy of Everett Irom any and all daims for damages, cosis, <br /> expenses, or causes of ac�ion lhat may arise because ot ins�allallon <br /> and main�enance ol Ihe improvement or other righl-ol-way usa here�o <br /> applied for and further apiees to remove same upon notice Irom the <br /> Approved for Construction Date City and to replace public properry damaged ihereby. <br /> F;NAL INSPECTION Date <br /> Approved as Construded Signature ol Applicant Date <br /> evcrMt PUBUC WORKSOEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETI�?N. THIS FERId1T MAY 8E <br /> Phone:?59-88i0 CANCELLED BY THE CITY UPON ANY STOPI'AGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />