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-1 <br /> �— -1 <br /> pateLC1—��� Pu01ic WorW Pa�rtiit f �� <br /> Applicalion For Bid9�Dept.+ <br /> PUBLIC WORKS PERMIT ����'�� PueTolelFeeFea s �L<, 1 <br /> rn ''�,� �ess noc�Fea re�a S � <br /> � �� ealenca oue S ' - <br /> Print or Type Only <br /> 3 �3-- <br /> ,'�vo� s�Q I"'�TR,��Rl se S s-S.x C�,l��c�c.»-,� �'�%.&�f,��,✓ r��-.� 3 �i 37 <br /> Owner Mailing Address Cily � ZiP Phone Z <br /> 0 <br /> --i <br /> �i��2 " <br /> m <br /> Applicant Mailing Address Ciry Lp Phone <br /> O � n � ] � � <br /> � U r .-. -� <br /> Describe Proposed Work - ' <br /> �/ N m <br /> ` v <br /> – c o <br /> — m o <br /> n <br /> --- � 0 3 <br /> m <br /> s� �-� > 3o J c-�.yP-E t�y � _ � <br /> Prolect Address(il known) m � <br /> .o z <br /> Attach fo�r(4)copies of plans(or proposed work• Draw to scale and note the tollowing as app�icable: � y � <br /> � PropeAY Lines � Cenlerline ol street '- _ <br /> • Outline and dfinensions of ell existing and • Indicate North K v� <br /> proposed structures on the lot - • Show any proposed grading changes T <br /> • Existing and proposed utilities • Show measurements M o z <br /> W � a <br /> � m <br /> DO NOT WRITE C:�eLOW THIS LINE O m � <br /> PERMIT CONDITIONS N <br /> 0 <br /> � o r <br /> 1. All calls for Inspection shall be made 24 hrs. in advance• phone 259•881 5. � m <br /> 2. All work shall be performed in accordance wilh this permit and current City of Everett Design and Construction � �^ <br /> 3 tn <br /> Slandards end Specilications. m <br /> 3. Call Location Undergruund Service 4B hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555. � � m <br /> ,p ��/�s ��./ � � ' <br /> � .�.,- a,o�o�a�� ��- �{ 8 A <br /> � <br /> _ <br /> b <br /> 2 <br /> � � <br /> 2 <br /> �--� <br /> � N <br /> � / Z <br /> � � O <br /> �,� 1� . � ��r,��� ,5 O m <br /> �� P � �. <br /> � ��p �� � � r <br /> � <br /> ACKNO\NLEDGEMENT UF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> — less the Ci!y of Everett Irom any and all claims for damages, wsts, <br /> �� ezpenses, or causes of aclion lhat may arise because ol installation <br /> ^�_ and maintenar,ce cl tne improvement or other right•ohway use hereto <br /> - - applied (or and further agrees to remove same upon notice fwm the <br /> Ap�r ved f r Consiruction �a�e City and to replzce public property damaged thereby. <br /> FINAL INSPECTION Date �,/� �J " ^' /� ' <br /> A�proved as Constructed S�g� Applicant (/ Date <br /> WORK AUTHORI'LED BY THIS PERA7IT MUST 6E STARTED WITHIN <br /> everett PUB�IC WORKS DEPARTMENT 180 DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32Q0 Cedar Slreet BE DILIGENTLY PURSUED TO �OMPLETIUN. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCEiLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8615 PROJECT OVER 90 DAYS DIIRATION. <br />