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Date� P�GLCWOrksPe�mil• L�8�G0� <br /> , � <br /> Application For Biep Deot���$�n� <br /> PUBLIC WORKS PER�VIIT Pu�TotslFee�ee s — <br /> Less Appl.Fee PaiO $�_ <br /> Print or Type Only ea����e o�,. s�__ <br /> T,�,�,�e l .-„ � ,vay�=��/�,K�A, Q.. E� iprf- 9�P n.� zs�-9.�9 I <br /> �Ow er M�n9 Address City Zip p�ia�� I <br /> S�M � <br /> Applican� Mailing Addre s City ZiF Phone <br /> DescnbeProposedWork �Puf /Xu>>�PX nN �qI r� ��rf� 07� n��� F.�/p�o_(�C�p/Lp <br /> �,_ — <br /> P•olectAddress�ifkr�own) 5�1�27 �� G��=�vQJODp /91��_ � <br /> Altach tour(4�copir.s ol plans lor proposed wo�k• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions ol all existing and • Indicate Nor�h <br /> proposed s�ruc�ures on ihe lot • Show any proposed grading chanqes <br /> • Existing and proposed ulilities • Show measurements � <br /> DO NOT bYRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall he made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be perlormed�n accordance with ihis permit and current City uf Everett Design and Construction <br /> Stendards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> PF�ve �,e,Uc�a..,�y .9c�E-� ao ' �i.',c . � <br /> (��2ti�ev� �„cu� � /5� �L�-�/��. ,Lre*zP/-�.�'a-r`� Gkr�-�-ti.�J � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apUlicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages. costs, <br /> �� _ /� expenses, or causes ol action that may arise because ol inslallation <br /> va71-a_._ �/!�/O�i� and maintenanCe of the imprOvemenl or olher righl�ol-way use hereto <br /> Approved for Construction , Dale applied lor and further agrees to remove same upon notice from Ihe <br /> � ��'" City and to puU ic property d ma9ed th eby. <br /> �/•�� 5�/y-��_ ���� �v-/ -8 <br /> FINAL INSPECTION � Date <br /> ;;pproved as Canstructed ignat e of A icant Date <br /> evcrett PUBLICWOPKSDEPARf•4ENT WORK AUTHORIZED BY THIS PERMIT NUST BE STARTED WITHIN <br /> � 3200CedarSireel 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt.WA 98201 8[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 UAYS DURATION. <br />