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Date Pu011c Worka Pvmit� _ <br /> Application For eiao.oac�.+ <br /> PUBLIC WORKS PERMIT °°°Ta:FeeFee s _ <br /> Leas AOc��Fee Pa�a $ _._ <br /> Print or Type Only AtlanceDue s __ <br /> 1'-J P r P .�P ��u��q(�f 1�.d � 1'r7� �o��/'t -- E ' ��d(� .2S�'-�ir� � <br /> Owner MailingAddress City Zip Phore <br /> � p�pla �Dnc�(,in hp ,1 1�,�, �a�l� I C✓�lElr .C.��d��7ry,� -�'l�a6 7 — <br /> Applicant MeilinpAddress � City Iip phone <br /> Describe Proposed Work I P Vl G�q i � M�J fA u A Mw An '�__ I���y,? � t.i;T_ <br /> ' .1 <br /> ProiectAddress�ilknown) r��ie�.`7 C [7�A_^� /Y-✓e �_J � <br /> � <br /> AUach four(4)copies ol plans for proposed work-Draw to scale antl note the lollcwing a5 applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate N�Kh <br /> proposed slructures on the lot • Show any p�000sed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls lor inspection shall be mado 24 hrs.in advance- phone 259•881 5. � <br /> 2. All v�ork shall be performed in accordance with thls permit and current City of Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �!/6'G/G Gclv/�LJ' ,�c'i•in�T .'UOT fJECil.�2E'/� ���7 O <br /> �f�� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEIdENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Clty of Everelt Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the imp�ovemen! or ofher right�of•way use hereto <br /> — applied Ior and further agrees to remove same upon notice from the <br /> Approved tor Construction Date City and to replace public property dama�+ed thereby. <br /> fINAL INSPECTION Ua�e <br /> Approved as Construd�+d Signature of Applicant Date <br /> evcrett PUBLIC YIORI<S UEPARTMENT WORK AUTHORIZ[D AY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Ceder Streei 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phonr 259•`i8�6'g'g0� CANC[LLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � PROJLCT OVER 90 DAYS DUR4TION. <br />