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/� �r��r� � � <br /> �B�BS�.11,J LJ Pubi c worb Far =��,�; g— <br /> BiJV Oep� � �1:J�J� <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT P���me�.a��� s_ <br /> Leu�00�fee PuJ S_ <br /> Beia�cn Ow f <br /> Print or Type Only <br /> �-�11� �b3 �� '� (yp, % � 120.� ��/�7�" � .�2�1-a87� <br /> Owner Melling Addiess Gty Zip Pnone <br /> � pppl� Meiling Address City Zip Phone <br /> DeacribeProposed Work �,r� u '�v �Df`�' � <br /> -� # W <br /> Prolect AdAreae(il known) � � � ; <br /> Atlach lour(4)coplea ol plane lor proposeJ work• Draw lo scale end�ola Ihe Ioilowing es applicable: � <br /> • Property Llnea • Cenlerline ol slreet � ���,� <br /> •Outline end dimenalons ol all eMieting and • Indicate North <br /> propooed struclures on ihe lot • Sn�w any proposed gradinp changes <br /> • Exiating end proposad utllltles • Show measurements � <br /> DO NOT WRITE BELOW THIS UNE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inepecllon ohall be mede 24 hrs.in edvance-phone 259•8810. � <br /> 2.All work ehell be performed in accordance with thle parmit and current City ol Everett Design and Conatruction <br /> Standerde end SDecilicatlons. <br /> 3.Call Locatlon Underground Service 48 hra.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � �, <br /> ��� 1��C�(JII..�Q Z � � � <br /> c��� H <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�si�ned owner/applicaN hareby ag�ees to hold antl save harm- <br /> — loss ihe Gly ot EvF�rett from any and all claims lor dameges, costs, <br /> ozpanses, or causes ol action ihat may arise because el installation <br /> and maintenance ol the improvement o� oth�r nght•of�wey use hereto <br /> applied I�x and lurlher aBrees lo remove same upon notice Irom Ihe <br /> ApOroved lor Cons�ruction Date Ci�y and to repiace Vublic property damaBed Ihereby. <br /> FINAL INSPECTION Dale <br /> Approved as Constructnd SignaWro ol Applicar� Date <br /> WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> evereft PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREFFTER I;. TO <br /> � 3200CederSlrael BE DILIGENTLY PURSUED TO COMPL.ETION. THIS PERMIT MAV Bt <br /> Everetl,WA 88201 CANCELLE�BV THE CITV UPON ANY STOPPAGE OF WORk ON THIS <br /> Phone:259�8810 PROJECT GVER 9U DA"5 DURATION. <br />