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�8t0�d7 ' � I <br /> Pu�Lc Wmwa Pa�m�' • <br /> Application For BitlB Dept • /�L2 <br /> PUBLIC WORKS PERMIT P��IicWo�hsiee <br /> Tol�l Fee s— <br /> Le���ppl Fee P�iE S_ <br /> Print or Typ� Only B�lu¢e0ue s <br /> G/el,_L�'/, /YI��,ti/n� ;i � �ver�ah�I �� Fi�PlPt�' �1�"1�1 339—�h� <br /> Owner Meilinp dtlress City Zip Phone <br /> Applicant MaI11ng Addresa City Zlp Phone <br /> ' Deacriba Proposed Work A(�1i tM ��,[����t/L�r 6��. <br /> Yi3 d—' <br /> -�nAi���fL2y+a <br /> Pro�ect Address(il known) Z�� � � ✓P!t n.�n . ��Ih. � <br /> Attach fow(4)coplee ol plene for proposed work• Dr�w to scale and nole the following as applicable: � ; <br /> • Property Lines • Centerllne of etreet � � <br /> • Outline and dimenelona ol ell exletlnp and � Indicale Norlh <br /> p�oposed etructures on the lol • Show eny proposed gredinp changes <br /> �. � ExletlnB end propoaed utllitles • Chow meeswemente � <br /> NO WRIT EL W THIS LINE � <br /> O ,I <br /> PERMIT CONdITIONS <br /> 1. All cslle lor Inspectlon ahall be made 24 hra In edvence• phone 269•8815. � . <br /> 2. All work ehall be perlormed In eccordanca with thia pe�mit end current City ol Everett Oesign and Constructlon <br /> Stenderde end Specllicationa <br /> 3. Cell Lotalion Underground Sarvica 48 hrs. beloro you dig.TOLL FREE NUMBER 1•800•424•5556. � , <br /> ��6ci� Ltic�i'.cS fE:���T �T O <br /> .c/_r .t'Fc,�c��,��co 7, Z -g7 H <br /> �� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ag�ees to hold and eave harm• <br /> less the Ci1y of Everatt Irom any and all cleims fo� dameges, costa <br /> expenses, or causes of action thet mey erise bacause ol Inetallation <br /> end meintenance of �he imp�ovement or ofher right-ol-way use herelo <br /> Apprc �ed lor Conetructlon Oata epplied lor and lurther agrees to remove same upon notice Irom the <br /> City and lo replace public property damaged Ihe�eby. <br /> FINAL INSPECTION Date <br /> Approved ea Conatrur,ted Signature of Applicant Date <br /> everett PUBIIC WORKS DEPARTMENT WORK AUTHOf712ED BY 7HI5 PERMIT MUST BE STARTEU WITHIN <br /> � 3200 Cedar Street iB0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere�f,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PEHMIT MA� BE <br /> Phone:259•8815 CANCELLED BY THE CITV UPON ANY STOPFAGE OF WORK ON 7 HIS <br /> PROJECT OVER 90 DAYS DURA110N. <br />