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i � <br /> , <br /> .. De1C�! � '�� f�"" PuOLCY/orYSPe^r+y II <br /> 61�9 Oe�l.� ���/ --- <br /> A�P�icaticn Fvr � i <br /> PUBLIC WORKS PERMIT °�°',""°""" --- ' <br /> ,o�a�Fe� s- , <br /> LessPnn� GnnPa:o S ( <br /> l'J�� <br /> c,i.,�c�o�� 5 <br /> Print or Type Only <br /> A�x <br /> H 1 �, /� c�L-��� <br /> ayti 1^� / � Y'1����a � ��}<<� �l�i� 11\� •�. 1��'%l�G'1`��-5 ' i <br /> ~ �~ Owner ��� Madmy Atltlress Ciry Z p Phone <br /> fG C] <br /> H:U <br /> °� H� tin .�n� <br /> N � � Phone <br /> yN� qpplicanl MailingAtldress City ZiP <br /> � Z �1 ���t///111I_ <br /> y d Describe Proposed Work 1F� � +-I� I 1��� ' � � '" �� <br /> � �8 <br /> �Y � <br /> � W <br /> r y H Prolect Address lil known� � `--' � <br /> g d�, � <br /> q C� Attach four(A)copies ol p�ans for proposed work� Dmw to scale and note t lollov+ing as applicable: � <br /> � �s� • Property Lines • CenteAine ol slreet <br /> T • Indicate North <br /> y yO y • Outline and dlmensions of all existing and � ShOw any proposed g�ading changes <br /> proposetl struciures on Ihe lot <br /> - • Existing and proposed utilrties • Show measwements /y� <br /> W <br /> DO NGT WPITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> j 1.All calls for inspeclion shall 6e made 2A hrs.In advance•phone 259-8810. �\ <br /> 2.All work shall be peAormed in accordance wilh this permit and current Cily ol Everett Design and Constmction ♦ <br /> �'� Standards and Specifications. <br /> ;.� 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �__ , � <br /> -(-��ui r� �� dB O <br /> � , :, <br /> ' r Y/ <br /> a' <br /> -- a <br /> ���� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 7he undersigned owner/applicaN hereby agrees to hold and save harm� <br /> �' � less the City ol Everett (rom any and all claims tor tlamages, cosls. <br /> ` <br /> expenses. or causes M action that may arise because ol instal ation <br /> and maintenance of the �mprovement or other righ4o(�way use hereto <br /> applied lor and lurther agrees lo remove same upon notice irom Ihe <br /> � ' Date <br /> Appmved lor Construction City and to replace public pwperty damage t ere y. <br /> FINAL INSPECTION Date Date <br /> Approved as Consirucled Signature ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> eve�ett PUBI.IC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlreal BE DIIIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EvereU,WA 98201 CANCELLED BY THE CIT1'UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />