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, <br /> Date�'�.5 Public Works Pnrmit a �J f� <br /> Application For eia9.000t.+ <br /> PUBLIC WORKS PERMIT , ��� Pu�7oteFeeFee s ,�� a <br /> L �ass aoo�Feo Paie S_�� <br /> 7G� eeia��a o�a S 2G,�9 <br /> Print or Type Only <br /> d l�y //ss�c ..a rt-S ->�'�n=/:. .GcvG �� t�i.r:c.r� c.�.J- ,v'��:c�- .�d 7-4coc) <br /> Owner Mailing Address City Zip Phone <br /> A�s /�!iv✓.:' <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �''7`��) ln2 �h�u� (���L��� m� - �S r�f'-- <br /> // i W <br /> Project Address(if known) ��f c%�7` �f9/���T�` � <br /> Attach tour(4)copies ot plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Properry Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities i Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITiONS <br /> 1. All calls tor inspection shall be made 24 hrs. in advance• „^hone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City ot Everett Design and Gonsiruction <br /> StanAards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> `r� ��' J �U!'/rz C�ii't rL C:cfc! �-aY CTYI "S•� �P O'>'I �, o <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of F.verett from any and all claims for damages, costs, <br /> / expenses, or causes of action that may arise because of installation <br /> � � �'�`�- l G�,�— and maintenance oF the improvemeni or other right•of-way use hereto <br /> fui""r' " ^7'���-C��7 applied for and further agrees to remove same upon notice from the <br /> Approv�C nsU� Date City and to replace public property damaged thereby. <br /> ��Q. � , l�'� <br /> F�NALINSPECTION Date �— ` a"/� �' a� <br /> Approved as Constructed ignatur pplicant . Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street 6E DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everr.tt,WA 98201 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />