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I <br /> I <br /> I <br /> � <br /> Date /// /7� v�eocwodaPe.mn• -�` / I <br /> Application For eiaa oso� . � . I <br /> PUBLIC WORKS PERMIT PueiotelFs:`.° : <br /> Lev�ppl.Fee Pn0 s <br /> Babnce Due a�n�� � <br /> Print or Type Only <br /> _ 2��0� ,��e r����__ �r�e�e � 9�2a/ �3�-2.3Q �' <br /> Owner Ma6ing Address Ciy 2ip Phone I <br /> �'zn�2b, /� ��.�z � /�u.� 94 ,�,����� 9�'�3� 25h���� i <br /> ApFlicent Mallinq Addre� Ci�y Zip Phono I <br /> Describe Proposod Work . �. <br /> _ W <br /> Project Address�il known) Q V � <br /> Altach lour 14)copies Of plens lor proposed work- Draw to scale end nole Ihe I011owing as applicable: � <br /> • ProCerty Lines • Centarline ol street � <br /> • Outiina and dimensions ol all exisling and • Indicete Nor�h <br /> proposed structures on Ihe lot • Show any proposed gradin{�changes <br /> • EKisting and proposed utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONLiiIONS <br /> 1.All cells lor inapection ehall be made 24 hrs.In advence•phone 259•8810. � <br /> 2.All work shell be perlormed in eccordance with this permit and current City of Eve�ett De�ign and Conslruction <br /> Stendarda and Specllications. <br /> 3.Cell Location Underpround Servlce 48 hrs.beforo you dlg.TOLL FREE NUMBER 1-80U-424•5555. � <br /> O ' <br /> � <br /> � <br /> O <br /> � <br /> � ACKNOWLEDGEMENT OF CONDITIONS , <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Cily ol Everett irom any and all claims lor damages, costs, <br /> .`�, / / . expenses, or causes ol action Ihnl may erise because ol installotion <br /> /�T !�('rn? 7 � ,� and maintenance of the improvemenl or other righ4obway use he�e�o , <br /> applied for and furiher agrees lo remove same upon notice f�om tho <br /> Approved lo� onst.�ion Date Cily and to replace public proVerty damaged thereby. �, <br /> , � 7 �3->/ ' <br /> � � i� -ii-<,,i a ,��/�,� �'�u�� �� I <br /> FINAL INSPECTION Date ,.t,�—���� <br /> Approved ns Conslruc�eA Signature nl A licant Date I <br /> �'�� F'UBLICWORKSDEPARTMENT WORK AU7HORI2ED BY TFi15 PEPMIT MUST BE STARTED WIiHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEA IS TO I <br /> 3�00 Cetler S�ree� BE DILIGENTLY PUR,�'iUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evere��,WA 9B201 CANCELLED bY THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> Phon�:259-8810 PROJECT OVER 90 DAYS DURATION. � <br /> i <br /> � <br />