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N �� °si <br /> Y �/�'}`/y) 4 � <br /> ` 7 � � PuUhc Wo�k1 Permil�J �/— � <br /> Date�ll� /� S pp � j� _ ` <br /> �Q� oinq.Dcot � �1 �L9�- — r <br /> i P APPlica�ion For _______ ' ��'.� <br /> � PUBLIC�QVVORKS PERMIT PuOliClYO�h9FCB -- ' <br /> Tatnl FCe $— <br /> t V �i <br /> ' lesa Anol Fr,e PxiO $ <br /> � O p �� �alancc Dun $ /v�� <br /> ` Print or Type Only = <br /> 0 � .��+ � li/ -- <br /> � °' oi oi .y� r r� <br /> ' N �OCdO � �'J <br /> � � M W N m <br /> i _ �h �� , A� 4� 3� -OS� <br /> � <br /> i — ~ ���� J Ci� 2iP Phone <br /> ' WnCf � � N i 1 f855 Y ',. � ,-:i� <br /> .. r � .P <br /> ; � �$ � � o � ?� <br /> � <br /> I �n� P Phone f <br /> ( qppllcant Madin�Address City Z�P <br /> � <br /> � n� u) i�'In�e� �dl om� ;11niy� .ZH � <br /> � Descnbe Proposed Work :1-c <br /> � _ W <br /> ¢ Projecl Address Ii1 known) f20s B.eoAvuJr��/ � <br /> � <br /> ; Attach lour�4) copies ol plans lor proposed work� Draw to scale and note the lollowing as applicable�. � <br /> • Property Lines • Centerline �f slreet <br /> � • putline and Aimensions of all existing and • Indicate North <br /> proposed strucWres on Ihe lot • Show any proposed 6rading chanyes <br /> � • Exlsting and proposed utilities • Show measuremeNs M <br /> W <br /> � DrJ NOT WRITE BcLOW THIS LINE O <br /> � PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in adv2nce•phone 259•8810. <br /> . 2.All work shall be peAormed in accordance with this permit and current Cily ol Everett Design and Construction <br /> Standards and Specifications. � <br /> ' 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> �, ��„� �-�o�orrQ� /��.,zs �u/r� <f-a� ��9 � <br /> / <br /> � <br /> � <br /> 0 <br /> a <br /> �CKNOWLEDGEMENT O�CONDITIONS <br /> The unde�signed o�vner/applicant hereby agrees to hold and save harm- � <br /> � . less �he City ol Everell hom any and all claims lor damages, cost�. <br /> � expenses, or causes of action that may arise because ol installa�ion <br /> �— �, .. and maintenance ol Ihe improvemenl or other righl-ol-way use herelo <br /> � �� applied for and iwiher agrees to remove sTme upon notice Irom Ihe <br /> pp ved or n cF �Dale ��ty and lo replace public p�operty damaged lhereby. <br /> � . , �� ,��� s�i /�'" <br /> � ��� —=-� /�-r��_ � � /� � � <br /> FINAL INSPECTION 'Date .. Date <br /> Approved as Const�ucted i n ure ol Applicant <br /> WORK AUTIIORIZED BY THIS PERMIT MUST 8[ STARTED WITHIN <br /> eve�etl PUBLICWJRKSDEPARTMENT � 180 DAYS OF DATE PERMIT IS ISSUED AND THFREAFTER IS TO <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> cverett,Wqgg201 CANCELLED BY �4E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc:25��8810 PROJCCT OVEP.;0 DAVS DURATION. <br />