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o6f9 , i a� O O � r���ni��wo,��r,�,m� . -- <br /> P�aa Den� � �— -- <br /> Application For <br /> PUBLIC WORKS PERMIT ^°°,o,a F:�`°° s <br /> Lee�Aon� ine Pua S!� <br /> OT�P�f!I��P i <br /> Print or Type Only <br /> L 7 1F'0r� -.-- <br /> Owner Mailmg Address Cny 7�n Phone <br /> Applicant Mailing Address Cdy Zip Phone <br /> i <br /> G <br /> Describe Proposed Work � <br /> W <br /> Proiect Addraes lil knownl ^��Gf� � <br /> Attech four(4)copias ol plens loi proposed work- 7rzw to scele and nole the lollowing as applicable: � <br /> • Property Llnes • Cenlerline ol streel � <br /> • Oulline and dimenslons ol ell exisling end • Indicate North <br /> proposed structures an Ihe lot • Show eny proposad grading changes <br /> • EKleting and proposed utllities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for Inepectlon shall be made 24 hra.in edvance-phone 259•8810. � <br /> 2.All work�ahell be perforined In accordanca with Ihls permit end current Cily ol Everett Design end Conatructlon <br /> Stenderda end Speciticallnns. <br /> 3.Cell Loceticn Underground Service 4B hrs.before you dlg.TOLL FREE NUMBER 1•800•424•5555. � <br /> � ��l��i���LW�-cD O <br /> ���� � Z 8 8 � <br /> . � <br /> � <br /> a <br /> ACKNOWL[OGEMENT OF CONDITIONS <br /> The unAcrsigned owner/npphcant hereby ag�ees to hold and save harm� <br /> — less the Gry ol Eveiett Iwm any and all claims for damages, costs, <br /> e�penses. or causes of ac�ion thal may arise beceuse oi instel�alion <br /> and maintenance ol Ihe Improvement or olFer nght�ol�way use hereto <br /> - apUlied lor and lurlher agrees to remove sama upon notice Irom the <br /> Approved lor Construc�ion �e�e Ci�y and to replace puhlic property damaged ihereby. <br /> FINAL INSPECTION �a�e pale <br /> Approved es Constructed Signalure ol AppGcant <br /> NlORK AUTI10RI2L0 BY THIS PERMIT N,UST BE STARTED WITHIN <br /> e�P�e�� PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSU[0 AND THEREAF7ER IS TO <br /> � 3200CederS�reet BE DIIIGENTLY PURSU[D TO CCMPLETION THIS PERMIT MAV BE <br /> EveretL WA 98201 CANC[LlEO BY THE CITI'UPON ANV STOPPAGE OF WORK ON THIS <br /> � Phono.259�8810 PROJECT OVEF 90 DAYS DUF7ATION. <br />