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Date_L-L.� ^� �"'� o„oi�r.wo,.,ae,mO�i. f <br /> Application For 81�g DeO� • ._.IZ�. __�_L_���. <br /> PUBLIC WORKS P�RMIT ��G����-�,�SF�� ------ <br /> to���F�e s_ _ <br /> tess Ano� �ee pam $ _ <br /> Print or Type Only �.��,,�=,.o,�� s__ <br /> �� ��.�e��► ly �C�+L�_—+��l� ,�-, ��► a���'I as-��h� <br /> Owner �i'q AtlUress C�Iy J 7ip Phone <br /> Applieant hlailin9 Address Ci�y Zip Phon� <br /> Describe Proposed Work ����( JV^ � � <br /> Prqlect Address(il known) o<—�I I I Q�� � <br /> Attach fow (41 copies ol plans for proposed work- Dr3w lo sc,Je antl note Ihe following as applicable � <br /> • Property Lines • Genlerline ol slreel � <br /> • Outline and dimensions ol all e<��sUn�.�intl • Indicate Norih <br /> proposed sL uciwea on the lol • Sho�v any pr.posed prading clianges <br /> • ExiSting and propOsed uliGfieS • Show measuremr.nts � <br /> DO lvGT WRITE BELOW THIS LINE <br /> F'E-RA1ff CONDI'fIONS O <br /> 1.All calls for inspection che�il be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be���edomeC n accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Undergio..�9 Service 48 i�rs.beforu you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> I 6J L f/�=��.J ���� O <br /> J <br /> • � � <br /> //D -�q O <br /> a <br /> ACKNOYlLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> less the Cdy cf Everetl I�om any and all claims for damages. costs. <br /> e�nenses. or causes of action Ihat may arise uecause ol installalion <br /> and maintenance ol Ihe improvemenl or other right-ol-way use hereto <br /> applied lor and lurther a9rees to remove same upon notice Irom the <br /> Approved lo�Construction Date City and to reptace public property damar,ed therebv. <br /> FINAL INSF'ECTION Date <br /> Approved as Consiructed Signature ol Applicant Date <br /> evemtl PUBLICWORKSDEPARTMENT WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS nF DATE PERMIT IS ISS�IED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUtD TO COMPLETION. THIS PERh11T MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK CN THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />