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I <br /> I <br /> I <br /> I <br /> I <br /> Date.�.�a�y-� . � �u�LCLVaFSPmmil• <br /> / / Btlfg �e0i.+ ����_ <br /> Application For ��-- - <br /> PUBLfC WORKS PE�iMIT PJOToIOIFp�Feo S - <br /> Less Ano� Fae Pxm S <br /> palance Duo $ <br /> Print or Type Only , <br /> 0„�.6 �a n �MIECr��O �I..n_ E✓ei+P7f �f��Il � �d� -0��J2— <br /> �°"'� Madin�Address City Lp h�ine <br /> �vere�'' 13Id�c J�c 5�06 ����o�,,�c1�� 9�'zo3 3S3-�i6,L_ _ <br /> qpplicanl Mailing Address —� ty Lp Phone <br /> Descnbe Proposed Work �r,V Atf6 7� �M f� <br /> W <br /> Project Address(il known) � ' Q � <br /> Attach four(4)copies ol plans for proposed work• Draw to scale and note Ihe following as applicable: � <br /> • Property Lines � Centerline ot street � <br /> • Outline and dimensions ol all exisling and • Indicate North <br /> . proposed structures on the lot • Show any proposed grading changes <br /> � Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shell be performeA 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•800-424•5555. � <br /> � �J ��-1 ,r/ �Z U / O <br /> ��K=�f'I �V'/!/ ��J/�)2-C'�/vD-! /I1Qi[.tiC/LI�A�� <br /> <� r <br /> �-�:,� f"�,,>f:-- � <br /> �_.����� N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby a9rees to hold and save harm- <br /> less �he City ol Everet� Irom any and all claims for damages, costs. <br /> expenses, or causes ot action that may arise because of installation <br /> and maintenance of the improvemen� or o�her ric�ht-ol•way use hereto <br /> — applied lor and lurther agrees to remove same upon notice irom the <br /> Approved lor Construction �"�•z City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Si9nalure of ApplicaN �e« <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everert,WA 99201 CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�0810 PROJEGT OVER 90 DAYS DURATION. <br /> � <br />