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Date���d'7 � ��.. _ ..,,;�-,.•m�.. � p ��� _ <br /> Applir,ation For eiae oem.• 1_cr��1a— <br /> PUBLIC WORKS PERMIT P°°�KW°�.F°° <br /> TWe�Fee s <br /> leaE Appl Fee Pa�tl s <br /> Print or iype Only 3eie�ceDue S <br /> r,o. E uo. �3 rm��Ps —.31�,_.,.�3.0 ,,�� ��-zoi zs�-s�9� <br /> Owner J Mailing Address ity Zip Phone <br /> SavHr — ! ���R � � 1�h ; 1 l�t,�n� 337 �fir��7�— <br /> Applicant Mailing Address City �� Zip Phone <br /> Describe Propcsed Work C_(7�n S��d C�" S Tt�f�r. P _'f �P!Y <br /> Project Address lil known) �J 7 Z �,�(n�� � <br /> Attach lour�4)copies of plana for pr�,.osed work• Lfaw to ecale and note the following as applicable: � <br /> • Property!ines • Centerline ot street � <br /> • OutFne and dimensions of all ezisting and • Indicate Norih <br /> proDosed strudures on the lot • Show any propOsed gr„ding changes <br /> • Exisling and proposed utilities • Show measurements � <br /> UO NOT WRITE BELOW THIS LINE O <br /> PEfiM1T CONDITIONS <br /> 7. All calls tor inspectiu�shali be made 24 h;s. in advance- phone 259•881 5. � <br /> 2. All worY,shall be perioimed in accordance N�ith this permi�and current City ol Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3. Call Location Untlerground Serv��ce qg hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /l/Q �l-�/�'`iC l2�%',lS /-�is-�"/!,i� ' ���yt _ /�'�" d� O <br /> �__ �,/ H- <br /> � <br /> T/�Cn <.✓ii=�� To� .5��'� !;,-,:-i�;� Ti�;'- O <br /> �-,,,, /��.«� ,����,��� ,��,� !�/'Fi�TE� � a <br /> T����/( T` �n� �<i�,'/i'C L i;?. <br /> ACKNOWLEDGEMENT OF CGNDITIONS <br /> The undersigned owner/apPlicant hereby ayreen to hold and save harm� <br /> less the City uf Everett irom any and all claim� ior damages. costs. <br /> expenses, or r6uses ol action ihat may arise because ol installation <br /> and maintenance of the improvement or other right-of�wav use herero <br /> applied br and further aqrees �o remove same upon nohr,e irom ihe <br /> Approved br Construction Date City and to replace public property damaged there6y. <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIFi PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 UAYS OF DATE PEFMIT IS ISSUED AND THEFEAFTEP IS TO <br /> Ev�.•rel�,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. T�iIS PERMIT MAY 8G <br /> Pho��tc 259-tl815 CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br />. PROJECT OVtH 90 DAYS DUR!TION. <br />