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f - <br /> Date� o D Pubi¢Wo�As Pmmit•Q "� <br /> �iOB Deol.• �l7 ��� <br /> Application For <br /> RUBLIC WORKS PERMlT °°°ro,aFeoFvo S _ <br /> Less FOPI�*se Pa�a $ <br /> Balance Dun $ � <br /> Print or Type Only <br /> -, <br /> r� � a� ,�a �r�,�� i���� � (���n,�v>�� vyu z� ��� .� �, �� a-�..-c� <br /> Owner �—^ Mailing ress Cily Zip Ph�ne <br /> �1/ I� <br /> Applicant Mailing Address City Zip Phone <br /> rb <br /> Desc�ibe P�oposzd Work �.� � �� `t' .� �LL�.IC <� <br /> ; `�'l_�t�►�_ � �' � l <br /> � <br /> - ��3� -- W <br /> Frolect 4dtlress pf known) ��L — �OLL�2"s� !��" � <br /> Attach four(4)copies o1 plans lor proposed work- Draw to scale and note the .ollowiny as applicable: � <br /> • Property Lines • Centerlir,e of s;reet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed siruc�ure5 on ihe bt • Show any proposed gradinc� changes <br /> • Existing and proposod utilities • Sho�v measurements � <br /> i DO NOT WRITE BELOW THIS LINE <br /> ( PERMIT CONDITIONS O <br /> 1.All celle for inspection sha�l be made 24 hrs.in advanc^•phone 259•8810. � <br /> �, 2.All werk shall be performed in accordance wi�n Ihis Fermit and current Ciry ot Everett Design and Construction <br /> Standards and Speciticatio�s. <br /> 3.Call Location l�nderground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-.�i555. � <br /> i O <br /> � <br /> � <br /> O <br /> a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> — less thn City ot Everett Irom any and all claims lor damages, costs, <br /> � , expenses, or causes ol action that may arise because of installation <br /> ' l�_� '/ 8g and maintenance of lhe �mprovemenl or other right-o4way use hereto <br /> y � lied lor and lurther agrees to remove same upon notice Irom Ihe <br /> Approved lor Co Date i� nd to replace puhlic property damaged thereby. <br /> 8 ��� �� � . � Z <br /> FINAL INSPECTIOM Date �L '<< ' �' "� �'^'��r � �`, �� <br /> Approved as Conslructed SI naUre of Applicant ' ^ Date <br /> evcrMt PUBUC WOPKS DEPARTMENT WORK AUTHORIZED BY THIS Pi=HMIT �1UST BE STARTED \NITHIN <br /> 780 DAYS OF DATE PERMIT IS ISSUED AND �I-ICREAFTER IS TO <br /> � 3200CedarSlreet BE DILIGENTLY PURSUC-D TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA98201 CANCELLED Bt 1 r.t CITY UPON nNY STOPPAGE OF WORK ON THIS <br /> Phonc:259�8910 PROJECT OVER�JO DAYS DURATION. <br />