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�.�r� <br /> Date �'f-Ux�"� P„�,�wo,wsve,m,!-�,.,- ,��— �7.i <br /> AppLcation For ein9 oeP�.• _/�(_ <br /> PUBLIC WORKS PERMIT v°°�,�w�,�=��� - ---- -- <br /> ro�ri F�.�, s .. . <br /> iess nnoi Poe Pa�a 5 <br /> Print or Type Oniy e��,�«o�� s �C'� <br /> �►�c-�s���t, C�� � ��1� � ,��,� �= ��,��- �, <br /> Owner Madmg Address Gty Lp Phone <br /> _ ���`7����� <br /> 4pplicant Mailing Address City Lp Phone <br /> Describe Proposed Work � r�� �U��.0 X <br /> Project Address(if known) G'�/-� A � � �i-XT�� ,�J / -- � <br /> � <br /> Attach tour(4)copies ol plans for propo5ed work- Draw to sc�le and nole Ihe lollowing as applicable: � <br /> � Property Lines • Centerline oi street � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> proposetl strucWres on the lot • Show any proposed,rading changa; <br /> � Existing and proposed utilllies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection sliall be made 24 hrs.in advance•phone 259•8fi10. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call location Underground Servi:e 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 0 <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLFDGEMENT OF CONDITIONS <br /> The undersigned owneUapplicaN hereby agrces to hold and save harm- <br /> less the City of Everell Irom any and all claims lor damages. costs. <br /> � / expenses, or ciuses ol aclion Ihat may arise because of installation <br /> / _ /� ��f� oD and mainlenance ol the impruvement or other right-ol•way use hereto <br /> _�` L�/'f^ <br /> Approved lor Con IruC 'r % � applied for and turlher agrees to remove same upon notice irom the <br /> Date City and lo replace puhlic property damaged thereby. <br /> ���` /�.>y.� -�� �`� �J /o �' <br /> FINAL INSPECTION ate � � �+' � <br /> ApU���ed as Ccnstruciad � nature ol Applicant � Dale <br /> everett PU�3LIC WORKS DEPARTMENT ORK AUTHORIZED BY THIS P RMIT MUST BE STARTED WITHIN <br /> � 320QCedarStreet 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 99201 ' 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 DA'/S DURATION. <br />