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-- - _ �. <br /> ��dq o„�,�,�Wo..,o�,m„. '/ <br /> DBiB eina osoi • .�q/_at��-7-�---.-- <br /> Applicaticn For <br /> PUBLIC WORKS PERMIT Pu4imWonffee : ----- <br /> Tolei iee <br /> lea��no� innPsia S <br /> 9elnnca Duv = <br /> Print or Type Only <br /> �pC�- a1�-�l�ct�, &!✓�I-��alor�- Q�aoc asa-sa�6 <br /> Owner Maiiing Atldress City Zip Phone <br /> SO�xI <br /> Applitant Meilinp Address City Zip Pnone <br /> Describe Proposad Wark _ �aa S'T alr�(/ hPM�.Si��e, �N1/���t,� . <br /> W <br /> P�olect Addrese(11 known) � <br /> Attech�.low(4)copies ol plens lor proposed work- Draw to scale and note the lollowing as apptica6le: � <br /> • Properry Linea • Centerline of street � <br /> • Outline and dimeneions ol all existing and • Indieale North <br /> proposed atructures on the lot • Shaw any proposed grading char�ges <br /> • Exleting and propoeed uNllties • Show meaeurements � <br /> DO NO RI E EL THI LINE O <br /> PERMIT CONDITIONS <br /> t.All c�lle for Inspectlon ehall be made 24 hre.In advance•phone 26�8810. � <br /> 2.All work ahell be peAormed In accordance with thle permit end wnent Clry ol Everetl Deeipn and CormWctlon <br /> Slendards�nd Speciflcatlona <br /> 3.Call loc�tion Untlerpround 9ervice 4B hro.belore you dip.TOIL FIIEE NUM�E111•800�42466a5. � <br /> ����� ����� O <br /> ��, z�,-a�j H <br /> � <br /> � <br /> � a <br /> ACKNOWLEUGEMENT OF CONDITIOIJfi <br /> The undersigned owner/applicant hereby eqrees to hold and navs.harm• <br /> less Ihe City ol Everelt f�om any and ell clalms lor damuyus, coete. <br /> e■penses, or causes ol ectlon that mey arise becauae ol inelallatlon <br /> and mainlenance of the improvemenl or other riph4ol-way usa hereto <br /> applied lor and lurlher agrees to remove seme upon notice Irom the <br /> Approved lor Conetruction Da�e City s-id to replace public property dameped thereby. <br /> FINAL 14S�cCTION Date <br /> ADProved �a Conetructed Signature ol AppliceM Da�o <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evereft PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phona:259•BB10 PROJECT OVER 90 DAVS DURATION. <br />