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il <br /> DateS�/�V S PubLtWorhsPcr �8 �`'3�z <br /> Application For o�da oao�.. <br /> C <br /> PUBLIC WORKS PERMIT P°°Ta,eFeoFea S — <br /> less AOP�.Fee Paie $ <br /> �QQO <br /> Print or Type Only ea�a��a o�o s <br /> �UP�11 ICbI-� l� �►2�11�U� � a� � - <br /> Owner �— Mailing Address ity Zip � Phone <br /> ��� <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work ___C._�"�L � �� Ll <br /> C'� ��f/� <br /> Prolect Address(if known) 7�-3Z — � G�Gf �`= � <br /> � <br /> Attach fcur(4{copies of p�ans for proposed work• Draw to scaie and note the following as applicable: � <br /> • Prope�'y Lines • �enterline of street � <br /> • Outline and dimensions of all existin9 and • Indicate North <br /> proCosed structures on the bt • Show any proposed grading changes <br /> • Exicting and piuposed utililies • Show measurements � <br />� DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.Ail calls for inspect(on shall be mada 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Stenderds and Specitications. <br /> ! 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> � O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEPAENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save I�arm- <br /> — less Ihe City ol Everett irom any and all claims for damages, costs, <br /> i/ erpenses, or causes of action that may arise because of installation <br /> '�i-��L� p G p� and mainlenance ol Ihe iioprovement or other ri3hhobway use hereto <br /> —//G' �� �� applied lor and lurther a�rees to remove same upon notice from the <br /> Approved lor Const � i� Date City nd to replace public property damaged therehy. <br /> ` �//�-�� Q` g� <br /> FINAL INSPECTION Date � � � � • � <br /> Approved as Constr,.cted i�nature ol Ap�l� n Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI D BY THIS PERMIT MUST BE STAR7E0 WITHIP! <br /> � 3200CedarStreet 180 DAYS OF OATE PERMIT IS IS. "C AND THEREAFTER IS TO <br /> Everell,WH 99201 BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MP.Y 8[ <br /> Phone:259-0610 CANCELLED BY THE CITY UPON ANY STUPPAGE OF 1NORK ON THIS <br /> PROJECT OVEri 90 DAYS DURATION. <br />