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�ate 1��7 : � <br /> ( ( Fublic Woiks Permplt r-,�� � <br /> Applicaticn For ema�oeoi.r��_�.��.1�_ <br /> PUBLI�C WORKS PERMIT PubIICWorksFee � <br /> To�a�Fea s _ <br /> Loss AppL Foe PeiC $ <br /> Pfi�i Of Type Only d��a��o o�a S <br /> Tariahn.r� Rs ���a-I(Lg�" A�e lvE ���L-�e11�i.u�--���..�z�.�:SQ'� <br /> Owner Mailing Address City :ip Phone <br /> CC<Jf1- C[av�.�f �fj ,�� l��- l �PI�P d�E p G,//�- ��� 8�,�;,-'�?— <br /> Appiicant Mailing Address Ciry Zi Phune <br /> DescribeProposedWork _ I C��iat�i� lVNt7/bVPN/AFl� �('� ^ � <br /> �t1'. .1 •—'— <br /> Pro!ect Address(if known) _ "f�'�S ;Jal��P,l=.i �� � <br /> . a �� L_, <br /> � �--- <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines . • Centerline ol street � <br /> • Outline and dimzns�ons of all existing and • Indicate North <br /> proposed structures on the lot • Show any Gropnsed gr2d(ng changes <br /> • Existing and proposed utilities • Show measurements � <br /> r <br /> DO NQT WP.ITE B�LOW THIS LINE O <br /> PERMIT CONDITIUNS <br /> 1. AII calis for inspeclior shall be mado 24 hrs. in advarce• phone 259-881 5. � <br /> 2. All work shall be pert�rm�d in accordance viith this permit and current City of Everett Design and Con:;tructlon <br /> Standards and Sper.i'�cu;ions. <br /> 3. Call Location Undergraand Service 48 Lrs. Gefore you dig.TOLL FREE NUMBER 1•800-424•555�5. � <br /> �</BL/G Cc�02tS �.a=.e�/T �tloT ��QU/.e,�.l7 O <br /> �/���.3i> <br /> A.F � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENTOFCONDITIONS ;' <br /> __ Tlie undersi�ned owner/applicant hereby aorees to hold�nd save harm• i <br /> less the City of Everett from any and all claims for damages, costs, i <br /> expenses, or causes ol action that may arise because of installation <br /> and maiNenance of the improvemeni or other right-of-way use hereto <br /> applied tor and further 2grees to remove same upon notice from the <br /> Approved;or Construc.ion Date <br /> City and to replace public property dama�ed thereby. <br /> FINAL INSPECTION Date I <br /> Approved as Constructed SignaWre of Applicant Date � <br /> everett PUBLIC W6RKS DEPARTMENT WORf: AUTHORIZED BY THIS PERMIT �1UST F: 37AfiTED WITHIN <br /> � 3200 Cedar Sireel 180 DAYS OF DATE PERtdIT IS ISSUEp AND 7L!.•lCAFTFR IS TO <br /> Everett.WA 98201 BE DILIGEWTLY ?URSUEO TO CQMPL':TION. THI:. ��ERMIT MAY BE <br /> Phone: 259-8815 CANGELLED BY7HE CITY UPGN ANY�fOPPAGE OF �VO^K ON THIF, <br /> � PROJECT OVFA 90 DAYS DURATION <br />