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Date�JL• � PUEL[Wcrk�Permi�� � <br /> Application For oieo oecc.��f,f <br /> PUBLIC W!DRKS PERMIT� P�°;o,�eeF� : <br /> Lesa AOOI fee VaiO S <br /> Print or Type Only e.�•�e o�d s <br /> �, /VP��,,Sti ��.�- r���� 3s3-9Sa �- <br /> �ner Mai4ing Address City Zip Phone <br /> 11�'�r'd! �rr��. �. �,�' Cb��i.i Z �—ys7 '7 <br /> Applicant Mailing AtlOress City Zip Phone <br /> Describe P�oposed Work �,yY- ��q,��F�vr��y�/N�/�— n i0 �,� !�.]��p����Y_ <br /> r��N11_ Lt�A/ Pcl fyLQ. �1�� 1v � J�y � <br /> 1T✓ � � JA�� �t I�A�� <br /> Proiect Address(it 'inown) �g' � l,�/6��7�. � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all exisling and • Intlicate Nor�h <br /> proposad struclures on Ihe lot • Show any proFosed grading changes <br /> � Existing and proposeC utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for inspection shull be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall bo peAormed in accordance with this permit and current City of Everett Design and Gonstruction <br /> Standards and Specificatlons. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> �UBG/G l,v0�°.e �,�,���T �t/oT,P,��u�.�'.o O <br /> a�/a s � <br /> `�� � <br /> O <br /> a <br /> ACKNpWI.EDGEMENT OF CONDITIONS <br /> ihe undersignetl cHneri�.ppllcant hereby agrees to hold and save harm- <br /> less the Ciry ol Everelt Irom any and all claims for damages, cos�s, <br /> expenses. or c3ase� ol adion Ihat may arise hecause oi installalion <br /> and maintenance of Ine improvement or other right-oi-way use hereto <br /> applied lor and further agrees to remove same upon notice Irom Ihe <br /> Approved lor Constmction Dale City and to replace Uublic propeity damaged Ihereby. I <br /> FINAL INSPECTION Date II <br /> Approved as Gonstructed Signatu�e ol Applicant Dale �I <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTNORIZED 8Y TFdS PERMIT MUST BE STARtED WITHIN I, <br /> � 3200CedarStreet 160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO , <br /> Everett,WA98201 BE DII.IGENT�Y PURSUED TO COMPLETION. THIS PEfiM1T MAY BE <br /> Phone:259�8870 CANC`LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />