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D8t@'��� � P�EbcWorhePer�� <br /> Blap.DeO��• � <br /> Appllcallon For <br /> PUBLIC WORKS PERMIT PUOTot�feeFee , <br /> Leu�00�Fea P�iC S— <br /> B�4ncs Due S <br /> Print or Type Only <br /> �Q.I�i �I c/l�l � ��� f�l..��1�.4`�Y� I�a .!� ��C:�C��- �a'�`�..�� <br /> Owner Melling Addrass City 21p Phone <br /> �:�'n (�n.A�ST �S E��>v-�PuJ �� �i�� k��.T,� 9���13 35 3��'7 <br /> Applicant Melling Addresa f City 21p Phone <br /> Deacrlbe Prapoead Work ��D�� �"��(�� <br /> W <br /> Pro�ect Addrens pf known) � ' -""" � I <br /> Attach lour(4)coples ol plans lor propoaed work•Drew to scale end note the lollowinp ea eppliceble: � <br /> C Property Linea . • Centerllne ul atreet � <br /> • Outline and dlmenniona ol ell exlsllnB end � Show any p opoaed aradlnp chengea <br /> proposed etructurea on the lot � <br /> • Exletlnp and propoeed ulllltlen •3how meeauremuNe <br /> N I L H LINE O <br /> PEFMIT(:ONDITIONS <br /> 1. All calle for Inepectlon ehell be made 24 hra In edvance•pnone 259•881 5. � � <br /> 2. All work ehall be perlormed I�eccordance with thle permlt end current Clty ol Everetl Dealpn end Conetructlon <br /> Stenderde and Specllicatlona <br /> 3. Call Location Underground Servico AB hra belore you dig.TOLL FREE NUMBER 1•800�424•6658. � <br /> /�lU✓f'��G l-.c�or'.tS Pc,ei��T �T E;�,v���E"'1� S //g7 O <br /> c� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underalgned owner/epplicant hereby aprees to hold end sava he�m- <br /> less the City ol Everett Irom eny end all clalme lor damapes, cost0. <br /> ezpenaee, or causes of ectlon thet mey arlse because ol inatallallon <br /> and maintenence ol the improvement or other right-ol•way use hereto <br /> epplied lo� and furthar agreea to remove eame upon notice Irom Ihb <br /> Approved lor Conatruction Date City and to replace public property demaBed thereby. <br /> FINAL INSPECTION Dete Da�e <br /> Approvod es Constructed Sipneture ol Applicant <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE UILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Evetatt.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPA6E OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />