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Dete � �.�i r�ei��woa.v . <br /> eiao oeo� •��- <br /> Applicetion For <br /> PUBLIC WORKS PERMIT P°^'�W°.`.`.. <br /> To��i Fea � <br /> '.au�ppl faa P�iO � <br /> B���nu Do� f <br /> Print or Type Only <br /> /� � e K -�c�5 � Cc��.._, �L� ( `i����' � ��- I��� � <br /> Owner Meiling Adtlress Ci�y Zip Phona <br /> �` G� M� f <br /> Appllcant�l �� Melling Addresa City Zip Phone <br /> Deacrl6e Proposed Work ��^ ^�� �''-�' — <br /> W <br /> Pro�ect Addreea pl known) � �� � <br /> Atlech lour(4)coplea ol plens lor proposed work• Drew to acele and note Iha lollowing as appliceble: � <br /> • Properly Llnea • Centerline of st�ee� � <br /> A Outline end dimanelons o�ell existlnp end • Indicale North <br /> propoaed at�ucliirea on�he lot • Show eny ptoposed grading chenges <br /> • E.�slinp end proposed utilitlos • Show meeaurements � <br /> DO NOT WRITE BELOW iF11S LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inepectlon shell 6e mede 24 hrs. In advance• phone 259•801 5. � <br /> 2. All work shall be perlmmed In eccmdance with Ihis permit and wrrent City ol Everetl Design end Construction <br /> Slandnrds end SpeGficatlons. <br /> 3. Call Lacelion Underground Service 4B hrs. belore you Jig TOLL FREE NUMBER 1•800•424•5555. � <br /> oT �EQv�,�E.O O <br /> �J f�E,�i�i: N � ������6 �` <br /> `��',,� � <br /> 0 <br /> a <br /> ACKNOWLEDGEMLNT OF CONDIiIONS <br /> The undersigned owner/epPlicant hereby agreea to hald end seve harm- <br /> � less the City of Everott irom eny and ell cleime lor demnges, coste. <br /> expenses, or cnuses ol ection that may ariae beceuse ol instelletion <br /> � and maintenance ol Ihe improvement or olher righPohwey use hereto <br /> applied for end lurther agrees to remove seme upon nolice Irom the <br /> Approve0 for Gonslruction Dete C1ty and to replacn public proper�y damegad Ihereby, ' <br /> FINf.L INSPECTION Dete -- <br /> App�oved es Construded Signature ol Applicanl Dnte <br /> WORK AUTHORIZED BY TNIS PERMIT MUST BE STAHTED WITIiIN <br /> everett PUBUC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar S�ree� BE DIIIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLEO BY THE CITY UPON ANV STOPPAGE OF WORK ON iHIS <br /> Phone: 259�8015 PROJECT OVER 90 DAYS DURATION. <br />