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Date� D �_��.�, v;,,�.,�..,m��. �� <br /> pnlp Deo� • — <br /> Applicalion For <br /> PUBLIC WORKS PERMIT ru�to�i�e��� : zs� `= <br /> ���s npn�.vne an�a S_�— <br /> 6a�nnce Oun S <br /> 2�� � <br /> Print or Type Only <br /> �f/�.(l�F`r �f'vtl�,..,i' Li1� y.1 S'0'Ji✓c/.s /1.. G��C �i.b•� 1..� �h1�� /c'7� /�/ 3 <br /> Owner Mailmg AdA�ess � C�ty Zip Phone <br /> �,✓I'�✓� r (7�Y/!r.s.ir �'n� C <br /> Applican� Mailing Atldtesa Ctly Zip Phonn <br /> OescribePropo;edWork _ .���f ✓�r�••'� 1� lJNnO•i- � n ��� /� Ceu `v��. .�� _��� <br /> T /�ln Vi/�w.r.��•`�l Si/ � /�NV Grt�e..�v � r�/i✓ <br /> / W <br /> Project Addressl�f known) ��� � ���¢ � � <br /> Attach four 14)copies ol plans br proposed work- raw to scale and nete Ihe following as apPlicable. � <br /> • Property Lines • Centedine of slreet � <br /> • Outiine and dimensions ol all exisUng and • Indicate North <br /> p�opDsed sVudures on ihe lot • Show any propOsed graAing changes <br /> • Exislinp and proposed utilitles • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITI(�NS <br /> 1.All calls for inspedion shall be made 24 hra.in advance•phone 259•881 O. � <br /> 2.All work shall be peAormed in accordance wilh this permit and wrrent City ot Everett Design and Consiruclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B h�s.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �. r.��� s�r�� �%an a� a�/ rn�s 0 <br /> s ��,� �.-�.-�-��/>s E— <br /> N <br /> . O <br /> a <br /> ACKNOWLGOGE��9ENT OP GONDITIONS <br /> The undcrsigned owneUapplicant hereby agrees to hnld and save harm- <br /> less ihe City ot Everelt irom any and all claims lor damages, costs. <br /> expenses, or causes ol action Ihat may arise because ol installatlon <br /> and maintenance ol the improvement or olher nghl�ot-way use hereto <br /> n apP�ied lor and turther agrees to remove same upon notice from Ihe <br /> d 1 !onstr ti � �a�e City and to replace public property damaged ihereby <br /> �� <br /> � �r�' i �-T d'S �� r� <br /> FINAL WSPECTION Date -3�6 �� <br /> Approved as ConstruC�ed SignaWre o1 Applicant Date <br /> WORK AUTHORIZ[D 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWOPKSDEPAR7MENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLV PURSUEO TO COMPLETION. THIS PERMIT MAY B[ <br /> Everett,WA98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�0810 PROJECT OVER 90 DAVS DURATION. <br />