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Date���0 b I �., . ��:...,�...,. ,, _1�'7� <br /> Applicat�on For F�aa oPni • _�� �IJ_:`LJ. <br /> PUBLIC WORKS PERMIT °°°°°W°�.`�° -- <br /> Toiei Fee s <br /> LeaaAppLFaePe�O S <br /> I �aiance Oue � <br /> Print or Type Only <br /> 1�c�J--�o�P�, �q � 7 Col v ���t1- ����nl .��a-��� <br /> Owner ' � Maihng Address �—Gty Lp Phone <br /> . . . ... . .. . .. . . <br /> .SAn� — <br /> Applicant Mailing Address City 2ip Phone <br /> Describe Proposed Work }��;f ' r - <br /> W <br /> Pro�ect Address(ii known) � <br /> Attach lour 14)copir,s ot plans lor proposed work- Draw to scale antl nole the following as applicable. � <br /> • Prope�ty Lines • Centerline ol sVeel � <br /> • Outline and dimensions ot ail existing and • Indicate Nurih <br /> p�oposed s�iuctures on the lot • Show any proposed yr2dmq changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE B[LfiW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work sball be pedormed in accordance with ihis permit and current City of Everetl Des�gn antl Consiruction <br /> Standards and Specitications. <br /> 3.Call Locatlon Underground Service 49 hrs.belore you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> �7�T /�r�(f 1��� �/S-B�9 O <br /> /` , � / � <br /> f� <br /> � <br /> O <br /> a <br /> ACKNOWL[UGEM[NT OF CONDITIONS <br /> The undersi;�eC owner/applicanl herebyagrees lo hold and save haim- <br /> Icss the Cdy cl Everett Irom any and all claims lor damag�s. costs, <br /> expenses. or causes ot aclion Ihat may arise because ol installation <br /> and ��aintenance ol the improvement or o�her ngh4ol-way use hereto <br /> . epplied lor and further agrees to remove same upon nohre irom Ihe <br /> Approved�or Construction Date City and�o replace publlc p�operty damaged Ihereby. <br /> FINAL INSPECTION Date . <br /> Approved as Constructed � Signature ot App!icant ���� <br /> c��rrrlt PUBLIC WORKSDEPARTMENT WORK AUTHORIZED 8Y THIS PEFMIT MUST BE STARTED WITHIN <br /> 180 �AYS OF DATL PERMIT IS ISSUED AND TNEHEAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA98201 (;ANCELLED 8V THE CITV UPON ANY STOPPAGE OF'NORK ON THIS <br /> Phone.259�9810 PI?GJ[CT OV[N 90 DAVS DUFATION <br />