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r---•---7ry�;.T,�.rL:s�i.��: t �. :.. ,+/h�r'•.:,,�: ;�-�c^r'.{.yf-r�if�r�!�C�iA�'�fi7A^�'i.T...,M i.....�.�1 <br /> pe�g '��` �,� ^ � PuCbc Work�Parmr �� <br /> Applicelion For eino oaai.r_ :�s_ <br /> PUBLIC WORKS PERMIT P�°To,W seFee , <br /> Lest�00�Fes Putl S— — <br /> Print or Type Only Bnl�nce Due = — <br /> �'-���n i►�n�� Tu� �l�i � ���`' d U,� I 1����� ��.��'tt�, U�- ����D� '7'ly- <br /> Ownnr Meiling Address���ily�p Phone <br /> .��� � ��- <br /> � Appllcant Malling Address City 2ip Phone <br /> Descrlbe Propcaed Work ����Ify'��� �� �. � �`--����/� �r�N� - � ��L' 1 Y�IdJ-.CilL�CG�-��lJ4-!/��N Q <br /> Pro�ett Addrese(il known) � `"� ` � �Lp:��/n r`� � <br /> � <br /> Altach four(4)coples of plena lor proposed wo�k• Draw to acele end note tha lollowing ae applicab�e: � <br /> • Property Linea � Centerline ol etreet � <br /> • Outll ie and dimensions ol wll exieting end • Indicate North <br /> propoevd atructures on Ihe lot • Show any proposed Q.eding clianges <br /> • Exieti�g end proposed utilities • Show measuremenle � <br /> DO NOT WRITE BELOW THIS LIDlE O <br /> PERMIT CONDITIONS <br /> 1. All cella lor Inepecllon shell be mede 24 hrs. In advanca- phone 259•88�5. � <br /> ^. All work ahell be perbrmed In eccordance with Ihis permd and current Clly of Everett Design and Conetruction <br /> Standards and Specllicelions. <br /> 3. Cail Location Undarground Service 4B hrs. belore you di9 TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> P�li c: u—U.r-.rs� rc'7�.—,: �/..-i T ,�L�n; �(�-;���i,f'f.C> �d�87 � <br /> f <br /> i J�/� � <br /> O <br /> a <br /> ACKNOWLE. ,EMENT OF CONDITIONS <br /> The undersignoA owner/epplicanl nereby agrees to hold and save heim• <br /> — less the City ol Everett irom nny end all clalms lor demapes, costa <br /> ezpenses, or caueas of actlon that may e�ise hecausu ol instellation <br /> and malntenence of the improvement or other right�of�way use herelo <br /> _ applled lor end furlher ag�eas to remove same upon notica irom the <br /> Approvod for Consl�uction Dete City and to repleco publlc proporty demaged ihareby. <br /> FINAL INSPECTION De�e � <br /> Approved es Conslruc�ed Siqnature ol Applicnnl Dete <br /> everett PUBLIC WOfiKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUS7� BE STARTED WITHIN <br /> � 3200 Cedar S�reet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � Eveiatl.WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK O���HIS <br /> PROJECT OVER 90 DAYS DURATION. <br />