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i <br /> I <br /> i <br /> I <br /> �-35Z y q�.-�_ � <br /> �BtQ� � PUUim Wur��Permn• � �-W� I <br /> Applicalion For A�aa oeoi •��� , <br /> PUBLIC WORKS PERMIT P°°°°W°,�.�°° - <br /> Tolel Fee S I <br /> Les�ApO� FeePara S � <br /> Print or Tyf�e Only Ba_ance Dve S_� i <br /> � ,�, �,�p, $ aa9 - y� Avelv S�i�2i,�L� 9ha �5 3��- oaz� � <br /> Owner Mailing Address City 2ip Phonr, �, <br /> I <br /> � <br /> Applicant Mailin�Address City Zip Phonc <br /> DescribeProposedWork NpW S�dc�U �r�.ui��A,��f <br /> I <br /> p /� W ' <br /> � <br /> ProjectAddresslifkno�vn� �V�L �y�l�'� �'N � ! <br /> AttaCh lour(4) copies ot plans lor p�oposed work• Draw�o srelu and note Ihe lollowing as appllcable: � <br /> • Property Lines • Centerline ol slreel � <br /> • Outline and dimensiOns of all exisUng and • Indicate Nor�h <br /> proposed struclu�es on the lot • Show any proposed grading changes <br /> • Eristing and proposed ul;lities • Show measuremen�s � � <br /> �as <br /> DO NUT WRITE BELOW THIS LINE <br /> PERMIT CUNDITIONS O <br /> 1.All calls for InspecNon sha:t be made 24 hrs.in advance-phone 259•8810. � <br /> � 2.All work shall be peAo�med ii�eccordence wlth�his permit and curien�Ciry ol Everett Design and Gonsiruc�ion <br /> Stende�ds and Specificatlons. <br /> 3.Cail Location Underground Service 4B hrs.beforo�/ou dig.TOLL FREE NUMBER 1•800•424-5555. � I <br /> !�. �^�STINrq <br /> —I , ANY GNANGE IN l—OGA•T�dJ OF THG piZ��/C�.,�t�Y A�L.oN O � <br /> SHALL. 8E A"F�O�CE� �i`C ��fB�..�C. I..IO��S C�PV- <br /> � i <br /> r/ ', <br /> � , <br /> � <br /> I <br /> AGKNOWLEDGEMENT OF CONDITIONS ; <br /> The undersigned owner/npplic�nt hereby a9ree5 to hold and save harm� <br /> � less the City ol Everett Irom �ny and all clalms lo� damages, cosls. �, <br /> ezpenses. o� causes ol aclion thal may arise Aer,aase nf installation � <br /> �" Q ,�^�A �/� and mamlenance ol Ihe improvemenl or other righho�-way use hereto i <br /> �°� applied lor and lurther agrees lo remove same upon noh�e Irom Ihe <br /> ApP���ed lor Constr c�ion Date City and to replace pubhc property demaged thereby. ' <br /> . �i1�c� �01—r— 5'J S <br /> FINAL INSPECTION Date ��r"�/� _ I <br /> Approved as ConslrucleA Signaiure ol Applicant Date I <br /> everetl PUBLIC WORKSDEPARTMENT WOHK AUTHORI2EU BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO ! <br /> Everell,WA9B201 BE DIUGENTLV PURSUED TO COMPLETION. TIiIS PERMIT MAV BE <br /> Phone:259�88�0 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS UUFATION. <br /> � <br />