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Date��,�� ��op$. . �.� � ` c�ouc wo,ks Pe,mn.[� ' ,,,�1p..1 <br /> i ` eieg.oea�..—yC g' ��-'�L,al�-- <br /> Applir.ation For � <br /> PUBLIC VVOFiKS PERMIT PublicWo�ksFea <br /> total Fee $ �— <br /> Less ApPL Fee Paitl $— <br /> Baianc���uc � <br /> Print or Type Only <br /> _�lYliT,IA��r S 3a 0 ��7 O -��� �� ��P U U � �.� �-0.3a t' <br /> Owner Mailin�Address City Zip � � Phone <br /> 33�-09'33 <br /> ti� U�rN�,h, �„_ � ra��3s����.s€��,, 9�r� <br /> Applicant ei�ing Address City Zip Phone <br /> Describs Proposed Work ��������Q/1� {N.V_ �;� S/I�p KL+ AOfI^ _ <br /> --- W <br /> � Project Addres_(if known) N � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and nole the follo inn as applicable: � <br /> • Prop=�7Y ���es e Centerline of slreet ♦� <br /> • Outlino and dimensions of all exis�ing and N Indicate North �� <br /> proposed structures on the lot �� Show any proposed yran:ny changes <br /> • Exisling and propcsed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for in.^.pection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormetl in sccordance with this psrmit and airrer�l Cily of Everett Design and Construction <br /> Standards end Specifications. <br /> 3.Call Location UnAerground Service 48 hrs.before you dig.TOLL FREE NUNBER 1-800•424•5555. � <br /> /�/�'z``� -�..�� O <br /> � �, F— <br /> � N <br /> � � A <br /> � �o�� <br /> � a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> lhe undereigned owner/applican!hereby agrees to hold and save harm- <br /> — less the City of EvereU trc�n any and all claims For damzges, costs, <br /> expenses, or causes o( action that may arise because of installalion <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remcve same upon notice from the <br /> ApProved tor Construction Date City and to replace public property damaged thereby. <br /> � FINAL INSPEGfION Date <br /> Approved as Constructed Signeture ol Flpplicant Date <br /> WORK AUTHORIZED BY THIS PERMIT tv1UST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 780 DAY;i OF DATE PERMIT IS ISSUED AND THEfi[AFTER IS TO <br /> � 320pCedarSireel BE DILIGENTLY PURSI�ED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,K'A98207 CANGELLED BY THE CITY UPON ANY STCPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURAT!ON. <br />