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A � � <br /> oate ��v/�l Puni�c Wo�xe Permn r C, � ��.� <br /> ' Appllce�ion Fo� BiCa Oep� • _ <br /> PUBLIC WORKS PERMIT °°°�o„Fee�ee ��_— <br /> iee��noi �ee P��a 6�_ <br /> Print orType Only AtlenroDue � �=�-� <br /> ��d'y�� <br /> `� � � /N/S � <br /> Ownar Meiling Addiess City Zip Phone <br /> S�r.�l��s s��-�ar ��l���y �v5"� c �s.�o �� F��r�e �`� <br /> Applicent 'Malling Addre Cily Zip Phone <br /> Dascribe Proposetl Work ���✓p ���u /V�y� <br /> W <br /> Proiect Addresa pl known) ���� C ` � � <br /> Atlech lour(4)copies of plena for p�oposed woik� Uraw lo ecele end nofa the following as applicable: � <br /> • Property Lines • Centerline o1 slreet � <br /> • Outline and dimenalnne ol ell e�isting end • Indicete North <br /> propo6ad struCtu�e9.�n the lot • Show eny proposed grading changr,s <br /> • Ealsling end proposad utllities • Show measuremenla � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calis lor Inapectlon ahall be mada 24 hrs. In advance� phone 259•881 5. � <br /> 2. All work ehell be pertormed In accordence wllh this permlt and curren�City ol Evarett Deslgn and Consiruclion <br /> Stantleids and Specilicallona. <br /> 3. Cell Locatlon Underground Service 48 hrs. hefore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> y ��� ���� ����� . 0 <br /> H <br /> N <br /> O <br /> a <br /> , <br /> ACKNOWLEDGCMEN7 OF CONDITIONS <br /> The undarsigned owner/epplicant hereby agrees to liold and save harm• <br /> � �. less the City ol Everett Irom eny and all claims lur demages, cosis. <br /> C ,^'� o^� � /� expenses, or causes ol action Ihal mny arise becuuse ol installation <br /> �����` `�� /.� �F-�, end muintenance of Ihe imFrovemenl or AAiher ri�hl-ol�way use herelo <br /> ��i �'� applied lor d luriher egrees �o remq✓{ seme upon notice M1om the <br /> Appr6 . r tr4cllp � Date City end pla public proqerty d?�«9ed Iherehv. <br /> , / � j �jJ <br /> FINAL INSPEC IUN ' � Oete > <br /> ApproveA as Constructed Signature ol Applicant Date <br /> evPrett PUBLIC WORKS DEPARTMEN7 WORK AU?HORIZED BY THI MIT MUST BE STARTED WITNIN <br /> � 3200 Cader Street iB0 DAVS OF �.1TE PER ISSUED AND THEREAFTER IS TO <br /> Eve�etl.WA 98201 BE DILIGENTLY PURSUE TO COMPLETION. 7HIS PERMIT MAV BE <br /> � Phone�. 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVLR 90 DAVS DURATION. <br />