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_ .� �_X� � � r��o��c a/a,��ve�m r <br /> Dete �� ��'F`��_ <br /> p��0 oeol • �.,�•_ <br /> Appllcetion For ' _ _ _ _ <br /> PUBLIC WORKS PERMIT °°"'�W°,",`.. <br /> Toiei fea f"_'_"_'"'. <br /> Len�oa� fee Vna S—_-- <br /> Bei�nce Oue 9___._ - <br /> Print or Type Onty <br /> ��-,�1�(l� ��1�;,l`' ��1 <br /> Owner Melling AdOress C�ty 21p Phone <br /> Applicent Mailin9 Adtlress City Zip Phone �— <br /> Descdbe Proposed Work �Q �V��� ' " �t � � <br /> �� � �1 `��� � <br /> • ` ��`,7� ' 1 �� � <br /> Prolect Addreee Ilf known) _ <br /> Atfech lour�4)copies ol plena lor proposed work- Draw lo ecale end nole Ihe lollowing as upplicable: � <br /> • Property Llnee • Centerline ol sireet � <br /> •Outline end dimensions of ell e�lsling end • Ind'aete NorM <br /> propoeed stmclures on the lot • Show any proposed giedinq chenges <br /> • Exlalinq ard propoaed utllilies • Show meesuremer�� M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITION9 � <br /> 1.All catle lor Inepecllon ahell be mede 24 hrs.In edvance-phone 259•8810. <br /> 2.All work shall ba performed In eccordence wlth ihle permit end current Clly ol Everett Deaign and Construclion <br /> Standards and Specillcatlona. <br /> 3.Cell Locatlon Underpround Service 48 hra.balore you dig.TOLL FREE NUMBEH 1•800�424•5555. � <br /> � 1 ) `��.� �1 ``�1,��/ ` O <br /> / / � <br /> � 9-�o-ae � <br /> � <br /> a <br /> ACKNOWLEDGGMENT OF CONDITIONS <br /> The undeisigned owneqepplicant horeby aBrees to hold end save ha�m� <br /> less Ihe Cily ol Everoll liom eny end all claims Ier demegns, coste. <br /> eRpenses, or ceusos of eclion Ihat mey erise because of instellalion <br /> nnd meintenence�N the improvement or other right�ol�wey use herelo <br /> applied lor entl lurther agiees to remove seme upon nolice from the <br /> Approved lor Construdlon Date City end to replac a public property dameged Ihereby. <br /> FINAL IrJSPECI'iON Date Date <br /> Approved ee Convtructed Signelure ol ApFiicam <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBIICWORKBDEPARTMENT 180 DAVS OF CATE PERMIT IS ISSUED AND THER[AFTER IS TO <br /> � 3:OOCedar 9t�ae1 BE DILIGENTLV PURSUED TO COMPLETION. THIS f'ERMIT MAV BE <br /> EvaretL WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WOHK ON THIS <br /> Phone:259�8810 PROJECT OVEF 90 DAtS DURATION. <br />