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Date L Ll�� r `, Pu�bc Wore�Permn• ��1 <br /> Application For aiau oeo��•�'�� ��r��L1— — � <br /> PUBLIC WORKS PERMIT PueTot�FeeFee , <br /> len�oo�.Fee Peio S <br /> Bsl�nce Due Z <br /> Print or Type Only <br /> IY 1�',_../�Lp� ��`�?( ����I� �i E=U��'��Il ��r=��,�; I �=�.`>>c- � 13�— <br /> Ovmer MellingAddress City ZiP / G� �,Phor1P <br /> l .. � ;n_�!� <br /> �,,,�n � .�s,, �� �1 f�l��-r; ��_s:� av�x���.0 r-'r Y'���'� �m�1r1iG5i��l�''- <br /> qppl!csnt MallingAOdress City .'�—ZIP Pho e <br /> Describa Proposed Work _1��� T � � K r �� ��11 Y � /������ — <br /> - W � <br /> ,� .� , _ ^ , � <br /> Pro�ect Addrese pf known� <br />, Attach lour(4)copiae of plena lor proposed work- Drew to ecale end note the lollowing as eppliceble: � <br /> • Proporty Llnea • Centerline ol s�reet � <br /> • Oi�!'ine end dimenalone ol ell existing end • Indicale North <br /> propoaed etructures on iha lol • Show eny proposed gradin0 chengea <br /> • Exlatir�Q end proposed utililles • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i. All celte lo�Inapection shell be mede 24 hra In advenca• phone 259•881 5. � <br /> 2. All work ehell be perlormed in eccordence with this permit and cunent Clly ol Eve�ett Design and Const�uctlon <br /> Stande�ds end Spacllicallons. <br /> 3. Call location Undarground Service 48 hrs. befora you dig.TOIL FREE NUMBER 1•800•$24•5555. � <br /> a <br />: <br /> �UBUG L�c'.�S �'F.�ir�iT.vnr,c'Fry��.,�Ea �_7�o e� O <br /> � <br /> � <br /> O <br /> a � <br />: � <br /> ACKNOWLEDGEMENT OF CONDtTIONS <br /> The underslgned owner/applicanl hereby ngreos to�old and savo harm� <br /> less the City of Eva�ett irom any and all claims Wi dema9os, costs, <br /> ezpenses, or causes ol aclion thet mey arise because ol instelletion <br /> end meintenence ol the improvement ar other righbol�woy use hereto <br />� applied lor end fuhher egrees to remove same upon notice irom fhe <br /> iApproved lor ConsVuction Dale City end to replace public property tlamaged ihereby. <br /> FINAL INSPECTION Date — <br /> qpprovad es Constructed Signature ol Applicent Dete <br />� everett PUBLIC WORKS DEPARTMENT WORK AUTHOHIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 1B0 DAVS OF DATE PERMIT IS ISSUEO AND THEHEAFTER IS TO <br /> � 3200 Cedar Slree� BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everet�.WA 9B201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone�. 259-�tS$p(X7 pROJECT OVER 50 DAVS DURATION. <br />