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�8�e�y ^ PuCirt Wor��Pnrm�t• <br /> Applicetlon For eiao oeo� • Q�1 /ti 9a1Y-�a <br /> PUBLIC WORKS PEF�MIT �����cWoiw�iee � <br /> Tol�i Fse <br /> Lae��Dal Iee nera S <br /> n.i.��,n�. 6_ <br /> Print or Type Only <br /> BO a � air�n.Q �,Yn�nrv �N /�D, ��.�.b7 .sr�1f/AaI.�9�'iay 3ya ��� <br /> pN,� �1 eiling Address Cily 2ip Phone <br /> ��� — <br /> ppplicant Alelling Addreas Clly Zip Phone <br /> DeacrlbeProposedWork � -�✓�u�-��Q,� a — •�//�y�^� "_'����n � <br /> _ � <br /> Pro�ect Adtlresa(II known) ` � <br /> Attach lour(4�copiea of plens lor pro0osed work- Draw to acele end notq the fo��owing as applicable: � <br /> • Property Line9 • Canterline of street � <br /> • Outline end dimenelons of ell ezleting and • Indicate Norlh <br /> propoeed atructures on the lot • Show eny proposad grading chengea <br /> • Existing end Droposed ut�litles • Show meesurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> �. Atl cells lor Inapection ahell be made 24 hra. in edvance-phona 259•881 5. � <br /> 2. All work ehell be peAormed In accordance with Ihis permit and current Clty ol Everett Design and Consiruction <br /> Stontlerdt end Speclflcatlone. <br /> 3. Cell Loce�lon Underpround Servlce 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> it/a f�,Bt�c tvcyz.es' �F,P.n�T �PFqv�,�� 8�/9� O <br /> c!i�� H <br /> //� <br /> V/ <br /> O <br /> a <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> The undersiBned awnar/npplicanl here6y eprees lo hold end seve harm� <br /> less ihe City of Everalt irom any and all cleims loi damegea, cests. <br /> expenses, or ceuses ol ection Ihat may eriae because of installption <br /> and maintenence ol the improvement or other righl�ol•waV use hereto <br /> applied Im and lurthe� agrees to remove eame upon notice Irom iha <br /> ApprovaA for ConeVucllon Date Cily and to�eplace public property dameged thereby. <br /> FINAL INSPEC710N Date <br /> Approvetl as Conalruclad Signature of Appllcant �e�e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIiHIN <br /> � 3200CedarStreet 1B0 DAVS OF DHTE PERMIT IS ISSUED AND THEHEAFtEN IS TO <br /> Everefl.WA 98201 BE DILIGENTLV PU(iSUEO TO COMPLETIUN. THIS PERMIT MAV BE <br /> Phone: 259�861 5 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />