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� <br /> I—,��(�� � ( PuCbt Work�Pe�mil e � <br /> ApplicationFor eiou.oeoi.• � 1' <br /> PUBLIC WORKS PERMIT PubTol°se"° s — <br /> Leu AoO�Fee Pa�d S <br /> Pfl�lt O� Typ2 Only eei��ceo�e f <br /> Ch�rk i'Y�rt� I a�aa C`r11�� ���g r,,��Frr c,uA � i �-y�� <br /> Owner Melling Address C� Zip Phone <br /> _��Idj"I IY/ ,__ <br /> Applicant Malling Address Cit)� 7.ip Phone <br /> Descrlbe Proposed Work r��.��.+r IrnP���'��`J 1 I <br /> a.�a2 �.� " W �' <br /> Projoct Addresa(if known) � <br /> Attech tour(A)copies of ptans lor proposed work•Oraw to scale and note��e lollowing as applicable: � <br /> i Property Linas • Cer.te�line of streel � <br /> • Outline and dimensions of all ezisting and • Indicate North <br /> proeosed structures on tha lot � Show any proposed grading changes <br /> • Exislinq and proposed utilities • Show measurements � <br /> DO NOT WRIlE AELOW THIS LINE <br /> PERMII CONDITIONS O <br /> i. All cal's lor inspection shall be made 24 hrs. in ativance-phone 259•8815. � <br /> 2. All work shall be peAormed in accordance with this permit and current Ciry ol Everett Desigo and Construction <br /> Stcnderda e�d Speciticetions. <br /> �3. Cali Location Underground�Service 48 hrs. bebre you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � . . � �/��/8� Q <br /> u�. .c ���,�,r,e-s- dE-.�h�,r ,c�-,; ,e.<<��,,rF� �. /- � <br /> 2�L <br /> � <br /> O <br />� <br /> a <br /> ACK�JOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/aF�licant hereby agrees to hold and save harm- <br /> less the City of Everett lrom any and all claims lor damages, costs, <br /> expen,es, or causes ot actiun th�t may erise because of installation <br /> and mainlenance ot the improvomen� or olher righl-ol�way use heroto <br /> applietl for and turiher agrees lo remove same upon nolice Irom Ihe <br /> App�oved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date /�Y/ /�z /� / Z�G� 7 <br /> j Approver as Consirucled �gnature 1 Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHO�iIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everetl,WA 98201 BE DIIIGENTLY PURSUED TO COMPIETION. THIS PEFMIT MAY BE <br /> Phone:2G9-8015 CANCELLED BY 7NE GTY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> PROJCCT OVER 90 DAYS DURATION. <br />