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- -- -..--: .�-_-�-�---- <br /> -----a- ----------�---------- --- -- <br /> Date�JJ_L]L,Ly �}-,� <br /> I "� PubLc WprFs Permil• , <br /> Application For eiey.o�ni.• <br /> PUBLIC WORKS PERMIT Pu�licWorksFec <br /> rairi F�� s <br /> Less Aool.Fee Paia $ � <br /> Print or Type Only e����«o�� s —�� <br /> �ok� ` LFVA��n�ySY1 7�ip� W l��Fn� �j3 l.V�t�ti't-T' ��d�3 �/- <br /> Owner Maihng Address ��� 7 � ���� <br /> c y Z�P Phonc <br /> — . )/Al�� r fIS� � 1-�-i0\l � <br /> /Apph ant �� ,y <br /> �u�eaa l.ity ZiP PhOnC <br /> DescribePrcposedWork �LANl� �(,T�{ 3 1 T(�(:ES AN7 �L /L10V.� \ �1YY ,��, � <br /> . <br /> � �.�M l� � �n Y/10/7=ne c� C/ �� �O Ltl <br /> Prolec�Address(if knownl — � - � ' , ; � � � <br /> U1 'N � <br /> Attach(our(4)copies ot plans for proposed work� Draw to scale and note the tollowing as apulicable: <br /> • Property Lines � <br /> • Centerline oi streel � <br /> • Outline and dimensions of all existing and f Indicate North <br /> proposed structurus on �he lot • Show any proposeA c�radin� changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS O <br /> 1.All calls for inspection shall he made 24 hrs.in advance•phone 259•$810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00•424•5555. <br /> � <br /> O <br /> � <br /> � <br /> f O <br /> a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS I <br /> The undersigned owner/applicant hereby ag�ees to hold and save harm- I <br /> � less the City ol Everett Irom any and all claims lor damages. cosis. <br /> � � � ezpenses. or causes ol action that may arise because of installation � <br /> tl � ��, j., / and maintenance of Ihe improvemen� or other right•ol-way use hereto <br /> Approved fo Construction applied lor and furiher agrees lo remove same upon notice Irom the <br /> Dale City and replace pu�C Pr erty damaged thereby. <br /> /� i <br /> FINAL I"ISPECTION Date � � ' ` <br /> Approved as Consiructed S� nalur, ol pNhcant Oate <br /> �� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��� 3200CedarStreet 180 DAYS OF DATE PERM17 IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE 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 DAYS DURATION. <br /> --- - ---- - --- - ---- - � <br />