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Date�O� r ( � P�o�,�wo,.,Pe, �. ]� <br /> A�pliCation For Biap Deo�.•�1�1� <br /> PU�LIC WORKS PERMI'• Pu00cWod�Fee <br /> iobl Fe� s- <br /> lew Appl Fee FaiC S <br /> B�hnce0ue S <br /> Print or Type Only <br /> �i I I C�n.vni�l� ���s �il� �,�;��'� A�l� I �- 7�j�— <br /> Owne� Mailing Adtlress Cily Zip Phone <br /> ��'Yl(►,�P1,�, ��� 7�i1]�l�lt/ ll� � k ' � UI ��-7�{51� <br /> pplicant Melling A' ess City 2ip phone <br /> Deacribe Propoeed Work .�,�C�,tn.����Yl/11� (�'LJ��f � <br /> i 1- �T —�C–� <br /> Prolact Addreas(II I;nown� �� ` �/'tFf'"� � <br /> Attach lour 14)eoplea of D�ens lor proposed work• Draw to sr,ale and note tfie lotlowing as applicable: � <br /> • Property Lines • Centerline ol stroet � <br /> • Outline end dlmenslons ol el1 exisling and • Indicete North <br /> propoecd atruclures on the lot • Show eny prr�posad prading chenges <br /> • Exlatlnp end propoeed ulilllles • Show measu��ements � <br /> DO NOT WRITE E�ELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1 All calls for Inapection shell be mede 24 hra in am��r.e•phone 25A•8815. � <br /> 2. All work ahall be perlormed In er,�ordance wllh thle parmit end current City oi Everett Dasign and Cansiructinn <br /> Stende�ds and Specifications <br /> 3. Call Locellon Underg�ound Service 48 hra belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �//�j'L/L ��,�.�'.�1� �.�i✓,n.T /1/G�j �f�rL�Ui�eE�, B/�'�A7' O <br /> c�q���l � <br /> '�5// <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> '.�he undersigned ownar/apulicant nereby agrees to hold and save harm- ' <br /> -- less thn Cily ol Everett from any and ell claims lor demeges, coatG <br /> erpenses, or causes of ecflon thet may erisa beceuse of fnstallation <br /> and meintenance ol the improve+nent or other righFol-way use hareto <br /> apptied lor and �urther agrens to remove same upOn notice from the <br /> Approved lor Construction �a�e City arid to replace public property damaged theraby. <br /> FINAL INSPErTION Date �I <br /> Approved ae Constructed Signature of Applicant �ata <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 32U0 Ceda�S�reet 1B0 DAYS OF DATE PEAMIT IS ISSUED AND TFIEREAFTER IS TO <br /> Everett,WP�98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 25f1�8B15 CANCELLED BY THE fITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PFOJECT OVER 90 DhVS DURATION. <br />