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88 -�3y� <br /> ���e� PubLG Wo�kb Pe�m�l Y <br /> � BIEp OeD� �— <br /> Applica�ion For <br /> PUBLIC WORKS PERMIT PubLCWO�keGee — <br /> Tota'Fae s <br /> Less l p01.Fee Gaia S �i O <br /> Balance Dve S G 0� <br /> Print or Type Only <br /> .�� � �n J IJ� ��✓ �L1 I �..��� ��,�Y [ � O�.C��O'cC1_1' <br /> �� . ai g Address Ciry Zip Phcne <br /> l..lf-.4--4��lJf� / <br /> � 1�11 �� ?�), ('rl�l��u� '` 98vi I <br /> Applicant MadingAddress City Zip P�one 1 ,�2_ M,� <br /> . t '_[ � CI'1 <br /> DBSCribe PrOposed Work ��� �� ! 'l ` ��`-" <br /> - W <br /> Proiect Atldress(if known) T ��8 — �'"'� �� �A� � <br /> Attach tour(4)copies ot plans for pmposed work- Draw to scale and note the following as applicable: � <br /> • Pioperty Lines • Centerline ot siree[ ♦A <br /> • Outline and dimensions of all existing antl • Indicate Norih V� <br /> proposed strucWres on the bt • Show any proposed grading charges <br /> • Existing and proposed utilities • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> f <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259�8810. � <br /> 2.AI�work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before yo��dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> � <br /> a <br /> �. ACKNOWLEDGEMENT OF CONDITIONS <br /> :'�� The undersigned ownedapplicant hereby agrees ro hold and saae harm- <br /> less the Ciry ot Evere[t from any and all claims for damages, costs, <br /> C���� � � �1 eapenses. or causes of ac[ion that maY arise because of installatiort <br /> �"- � O _.�/ �/!� c70 and maintenance ot the improvement or other righhof-way use hereto <br /> {/L/L /�jJvu/'` 00 applied for and iurther agrees to remove same upon no[ice from the <br /> qppn�,. ' ��. C��� u i� Date Ci[y and ro replace public properry damagetl thereby. <br /> �r� �� � '� <br /> -� � -��� 8 Z�-� <br /> FINAL INSPECTION Date Date <br /> qpproved as Constructed S gnature of Appli nf <br /> WORK AUTHORIZED BY THIS PERMIT MUS� BE STARTED WITHW � <br /> everett PUBLIC WORKS DEPARTMENT 780 DAYS QF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERfv11T MAV BE <br /> Everett,WA98201 CANCELLED BV THE CITV UPON ANV STOPPAGE OF S^.�ORK ON THIS <br /> Phone:259-8810 PROJEC��O\� '90 DAVS DURATION. <br />