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f—______�� _ � <br /> �L ��c C<.a.i��. <br /> Date� �� S Z�. $ f 8 '' � <br /> �b o�pLc Wo�Ms Permn e _/�-� <br /> Application for Biaq Dvo� � <br /> PUBLIC WORKS PERMIT � / P�b���W�.��«< —�� <br /> //77 ,o�.�F� s�.C�_ <br /> /J/� iensAoo� reePnm S <br /> Print or Type Only � � ea�*�,-�o,�a s <br /> ���SL.�. j '/Omll (°�/��✓r. Ever�}!� <br /> Owner Mailmg Address � Cdy Lp Phonr. <br /> l,G�k✓�r�r�/ .�... �. �/s�c=/yA... 1'� Fvt,-� ff 9FaaP 3.�7-�OG[ <br /> Applicanl Mailing Atldress City Zip phone <br /> Describe Proposed Woik .y�jd�/�j'(!�/w !/�� � j '��11py (�N��1{GE�_Yy�_ <br /> � J J <br /> ProjeG�Addresa(it known) �l� tL(J��V f{✓f . � <br /> � � <br /> Attach fow(4)copies ol plans for proposed work• Draw lo scale and note Ihe lollowing as eppGcab�e: � <br /> • Property Lines • Centerline ol s�reet � <br /> • Outline and dimensions ul all exishng and • Indicale Norlh <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilifies • Show mrasurements � <br /> ❑ �OT WRITE BELOW TH�S LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor Inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with this pe�mit and curreN Cily o�Everett Des�gn and Construction <br /> Standards and Specificetions. <br /> 3.Call Location Underpround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �� P.�,- ��,-�-F����ris 0 <br /> � <br /> H <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Cfly ci Everett from any and all claims lor damages. costs, <br /> expenses, or causes of action that may anse because of installahon <br /> _ and maintenance ol ihe improvement or other nght�ol-way use hereto <br /> ove brCp strucii`> applietl for and lurlher agree=_ to remove same upon noUce Irom thr <br /> / Date City and to replace puhhc properly damaged thereby. <br /> � 'o�- �- �r-� `pGy� I, <br /> FINALINSPEGTION Date �.�N ,/.L�1_"Q_ � <br /> Approved as Constructed ignatme ot Appiicant Date �, <br /> everell PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT hAUST BE S�iARTED WITHIN ' <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEA IS TO <br /> Everelt.WA 98207 BE DILIGENTLY PURSUED TO COMPLET�ON. THIS 1=ER�".iT MAY �[ <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OV[R 90 DAYS DUFAI ION. <br />