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� <br /> r �' <br /> � � <br /> Fu011e Worka Permll• ���� <br /> Date� <br /> eiao.oao�.+ <br /> Application For <br /> PUBLIC WORKS PERMIT P�bTOW e�Fee s <br /> Leee�OG�Fee Pe1E _ �J-3/�� <br /> a.�,��a o�a a—�O,OD <br /> Print or Type Only l,,�o r,� �5 g _g�'3� <br /> �� � rC n d a s2i•�sep?J �o� cCo��S�D���e�'vcr��f/— � �.� - 9 � 2/ <br /> Owner Mailing Address City Zip Phone <br /> � S� �nc� _ <br /> 0 <br /> Applicant Mailing Address City Zip Phone � <br /> n <br /> �— m <br /> Deacribe Proposed WorkJ~ ` Orl S�Y UC�` � � ~� � � " <br /> .-. .. <br /> --1 �7 <br /> o--� —1 <br /> 1/� x <br /> W m <br /> m o <br /> Prolect Address(if known) , <br /> I'CS� _ > VC � o� <br /> Attech four(4)copiea ot plans for proposed work• .Jraw to scale and note the following as applicable: � _..Z.� <br /> • property Lines • Centerline of street � m <br /> .. <br /> • Outline and dimensions of all existing and • Indicate North Q = <br /> • Show any propose�l grading changes � <br /> proposed structures on the lot � � _ <br /> • Ezisting and proposed utilities • Show measurements M ,..,..., <br /> W � �' <br /> < <br /> DO NOT WRITE BELOW THIS LINE O � � <br /> PERMIT CONDITIONS � _� <br /> 1. All calls for Inapection shall be made 24 hra in advance• phone 259-881 5. � m� <br /> 2. All wotk shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction o y <br /> Standards and Specification& <br /> 3. Cell Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � � m <br /> 3 tNi� <br /> m <br /> O z c� <br /> .�m <br /> a <br /> A <br /> � � <br /> S <br /> a <br /> � <br /> � <br /> x <br /> O � <br /> N <br /> z <br /> a � <br /> � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save herm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> /�6.e D,G, expenses, or causes of action lhat may arise because ot installation <br /> —, and maintenance o( the improvement or other right•of-way use hereto <br /> �� �p� � J/ 8S applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> ��/� �c���-3 -�� /� D. .�r � � ( � �� <br /> FI N ECTION Date Dale <br /> Approved as Constructed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITH�N <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTEH IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8815 pROJECT OVER 90 DAYS DURATION. <br />