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D2te.(�g�.�� � r.�a;i�r,.,��,n����,i, � ? <br /> Application For ei�y o�pi . _ 1�]�—�—��� <br /> PUBLIC WQf�KS PERMIT P°°"""°'"„Ce — <br /> Totel Tee S <br /> leuRppl Fee Pa�C � <br />� Balence�ur S <br /> Print or Type Only <br /> �ni/ Aln�{� ���'�r.i �r�? �S �1y�,3 -S*� N'41/• �?e, 7cS�) Sn'.t�/o 9cfi/iz 7�l' 9-�7�7 <br /> Owner �r � Mailing Address Ci�y Zip Phone <br /> -Sh n1(_ — <br /> Applicant Mailing Address City Zip Phone <br /> n <br /> Cescribe Proposed Work _ �..(��[_1_1L1�Z1LEl�(q-ll i <br /> L / � i/ <br /> - - - W <br /> Proje:t P.ddress(ii known) 1S� � ��J�:1�Lld�-� --- H <br /> / <br /> Attach lour(4) coples o1 plans lor p;oposed work• Dra�,v to scale and note tfie Inllowing ac anPlicable: r <br /> • Property Lines . • Centerline of sUeel � <br /> • Oulline and dimonsions of all existiny and • Indirate North <br /> proposed s�ructures on Ihe bt • Show any rroposed grading chanaes <br /> • Ezisting and proposed utilities • Show mensurements M <br /> W <br /> UO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perbrmed in accordance with this permit and current Cily ot Everett Design and Construcf�on <br /> Standards and Specilications. <br /> 3. Call Location Undarground Service 48 hrs. hefore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> 1��r/_.3�iC GrJo�S �E",Qin>T �IIOT .Q.F�avi,�E.o � �/5�87 O <br /> ��;.�' �. <br /> N <br /> O <br /> a <br /> ACI<NOVJLEDGC-MGNT OF CONDITIONS <br /> The undersigned o�.vner/applicant hereby agrecs to hold and save harm- <br /> less the Cily of EvereU irom any and all c!aims tor damages, costs, <br /> expenses, or causes of action that may arice because of installation <br /> and maintenance of the impiovement or other ri9hbohway use hereto <br /> apclied tor and furlher agrees to remove same upon nolice from the <br /> Approved tor Construclion Date City and to replace pu6lic property dama9ed thereby. <br /> fINAL INSPEC710N Date - <br /> Appwved as Constracted Signafure ol App��icant �ate <br /> evereU PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THtS PERMIT MUST 8E STARTBD WITHIN <br /> 180 DAYS OF DATE PcRMIT IS ISSUED AND THEREAFTEI? IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERAIIT MA� BE <br /> Eerell,WA 9B°01 CANCELIED BY THE CITY UPON ANY STOPPA3E OF WOFK ON THIS <br /> Phnne: 259�8815 PROJECT OVER 90 DAYS DUFATION. <br />