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D8t@.�LL'Q� , . � r,mi��:wo�wsre���n. -- <br /> Appllcation for BIJp osa� . <br /> PUB�IC WORKS PERMIT '°°:o�;feeFee s <br /> lrasAoo� �eePeie S <br /> Print or Type Only �3a�.���u�a s <br /> J�P.i� D ,37D� ��ATTZ�. i/X�- �1 �s-� <br /> Owne� MallingAddress Ci�y Zlp Phone 3y2-8�.� <br /> 11�h�- .s�h�dCh�'I" I-�r�Ur" �n5i-. �'n. U�5 �1�i�i5 It�. ��ri t� q�2�1 <br /> pplicant Malling Address City 2ip Phone <br /> Dencribe Propoead Work ��� f��- F�,�rn� /'11 ��r n c.1_V �! � t��_]I 1 (�l A� �`L(�(� <br /> ProJect Addreee(il known) �y�� � Q 7 , � <br /> Altach lour(4)coplea of plens lor proposed work• Draw to scale and note the lollowing as eOPlicable. �. <br /> • Property Linea • Centerline ol street � <br /> • Outllne and dimenslons ol ell exlsting and • Indicate North <br /> propneed etructures on the lot • Show any proGosed gr g changes <br /> • Exls:inp end proposed utilitlea • Show measurem � <br /> DO NO�f WRITE BELOW THIS O <br /> PERMITCONDITIONS <br /> 1. All calle for Inspection ahell be made 24 hrs. in adva -phone 259•8815. � <br /> 2. All work ehell be pertormed In acco!�tance with permit and current Clly of Everett Design and Construction <br /> Standarda and Specllicationa <br /> 3. Call LoceNon Undarground Service 4B .before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �!/,�L/G O,d,C S PFi.�rn,T yUT REt�r�i�EO O <br /> 2�/87 � <br /> / � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONOITIONS <br /> The undersigned ownei/applicant hereby agrees to hold and save harm- <br /> less the Cily ol Everett from any and all clalme to� damages, cosl& <br /> pxpenses, or causes of action that mny arise because ol installation <br /> and mainlenance ol ihe improvement or other�ighl�chway use I�ereto <br /> applied for and lurther aprees �o remove same upon nolice from the <br /> Approvetl lo�Consfruction Dete Ciry end to replace public property dameBed thereby. <br /> FINAL INSPECTION Date <br /> Approved a�Construcled Siqnalure ol Applicant Date <br /> everett PUBLIC WORKS DEPAFTMENT 4VORK AUTHORIZEU BY Tfi1S PERMIT MUST BE STPRTED WITHIN <br /> � 3200 Cedar Slreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREA�IER IS TO <br /> Evere�t WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV 8E <br /> Phona: 259�Bt115 CANCELLED BV 7HE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJEC' OVER 90 DAYS DURATION. <br />