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Dete • -. ,..,. I <br /> Puebc wab Perm�• <br /> Applicetion For emu o<;�.. <br /> PUBLIC WORKS PERMIT PuoimWorA��es —� <br /> Totel Iee S_ <br /> Leu�on� fee vuo 6 <br /> Print or Type Only B�IenceDun f <br /> ���� o l,V��.s � `I�4 Cm�r po �v�-n.t� 1�820s .�s3 7�3 <br /> Owner Malling Address �i� <br /> Y ZiP Phona <br /> d�E <br /> ApD��cdnt Mailing Add�ess City Zip Phone <br /> DeacribePropoaedWork Cm�-Ie�Tt'Y _�__�t[�(Lp,C�c� /N ���� Y�� <br /> W <br /> Prolect Address 111 known) � <br /> Attach lour(4)copiea ol plans lor proposed work-Draw to scale pnd note the lolluwing as epplicable: � <br /> • Property Llnes • Centerline ol st�eet � <br /> • Outline end dimensiona ol all ezlating and • Indicate North <br /> prop0aed atruclurea on Ihn lot • Show any p�opoaed greding chenges <br /> • Ezfsting end proposed utllitles • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls lor innpection ehall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work ahall be perlormed In ecco�dance with this permit and current Clty ol Everotl Design and Conat�uction <br /> Standarila end Specilicatlons. <br /> 3. Call Locatlon Underground Service 48 h�s. belore you dig.TOLL fREE NUMBER 1•800-424•5555. � <br /> �GC� �E,�/�ii �t-b�2Fc�G-r.PE�O O <br /> ��6/86 � <br /> i� / <br /> ���� � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tho�ndersigned owne�/epplicant hereby egreea to hold and save harm- <br /> less tha Cily ol Everetl Irom eny and all clalma lor demeges, costa <br /> expr.nses, or causea al action that may eriee beceuse ol Instellatlon <br /> and meintenance ol Ihe improvement or olher riphbo4way use hareto <br /> Approved lor Conslruction epF�ied lor end further agrees to remove eame upon notic9 Irom �he <br /> Date City end to replace public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Signature ol Applicent Date <br /> everett PUBLIC WORKS DEPARTMENT bVORK AUTHORIZED 8V THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 1BG DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,Wq g8201 BE DILIGENTLV PUFSUED TO COMPLETION. THIS PERMIi MAV BE <br /> Phone:259�8815 CANCELIED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />