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Date�'�C� <br /> PuDI¢Worhs Permit� ( 1 ' <br /> Appliwtlon For <br /> B�CB Oap� �_�� <br /> PUBLIC WORKS PERMIT P�°;a,aFgo`a^ g — <br /> Lens4o0LFcePeiG $ <br /> Print or Type Only o�����eo�, s <br /> ��,�ll' �'1�ils �1111 1 �'Pl(L-{7�r1 , <br /> Owner MailmgAddress ��� <br /> y Z�P Phone <br /> ��-`��L.--� l.l�l ���-��l �-����� � � � 2'���- � <br /> ApplicaM Mailing Atldress Ctly Lp Phone <br /> Desc�ibe Proposed Work �A! Ll�X( I,�L _ .���J ' <br /> Prolecl Address Iif known) � �,(�� � <br /> Atlach fom(4) topies ol plans for proposed work� Draw to scale and note the iollowing as applicablP. � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions ol all existing and • Indicale Nor�h <br /> proposed strudures on the lot • Show any propoe�sd grading changes <br /> • Exi=hrg and proposed utilities • Show measurements _ � <br /> DO tJOT WRITE BELOW THIS LIME <br /> PERMITCONDITIONS � <br /> t.All calls for inspection shall 6e made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with�his permil and currcnt City ol Everett Design and Consiruction <br /> Standard;and Specifications. <br /> 3.Call location Untlerground Service 4A hrs.before you dig.TOLL FREE NUMBER 1-800-424•55$5. � <br /> � C / /_ � O <br /> ! lC- Gc�e.c�a" lC/�d�.i'-o� „(%1>n.G ����L�ly�-`Y;Zi=�/ � <br /> 9 � <br /> I. <br /> O <br /> � <br /> ACKNOVJL[DG[MENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City of Everetl Irom any and all claims tor damages, costs, <br /> expenses. or causes ol aCtion Ihat may arise becaus� of installallon <br /> and maintenance of ihe impiovement or other right�oFway use hereto <br /> Ppproved lor Conslruclion applied for and Iwther agrees lo remove same upon notice trom the <br /> Date City and to replace public properly damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructcd Sipnature of Applicant Date <br /> everett PUBLICWORK��EPARTMENT WORK AUTHORIZED BY THIS PERAIIT MUST BE STARTED WtT111N <br /> � 3200CedarSlir.et 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA98'OS BE DILIGENTLY PURSUED TO COMFL[710N. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPP�IGE OF WORK ON THIS <br /> FROJECT OVER 90 DAYS DURATION. <br />