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Date��c' 1 PUUIi�WaiFs Peyn�m1''•�� <br /> gIE9.Depl+ � J 1 <br /> Applicatioa For <br /> PUBLlC �"4RKS PERMIT PUbTOIaFeoFca 5 <br /> Less npp�.Fee Paia � /Q pO — <br /> � <br /> �alnnoc Due <br /> Print or Type Only <br /> �.�� �� .� I�li� �?vl�.�Q;��/llr-,rno (k' �,t��" �/'�� �-Q500 <br /> Ma � Address City Lp Phone <br /> Owner <br /> Il-►►rrn�� r ,�rv�Y9�l'1 I �� 6�_ � �-5�� <br /> pplicant <br /> Madmg Address City Zip Phon� <br /> � <br /> Describe Proposed Work <br />� W <br />�� /lv/G - EoG.E:�vv.e L.i✓- � <br /> Prolect Address(if known) <br /> � <br /> Attach four(4) copies of plans for proposed work• Draw lo scale and note the following as applicablu: � <br /> • Properry Lines . • Centerline ot sl��f t <br /> • Outline and dimensions of all existing and • indicate North <br /> proposed structures on;he lot � Show any proposed gra�lin9 chsnges � , <br /> • Eristing and proposed utilities • Show measuremenis <br /> DO NOT WRITE BELOW THIS LINE O - <br /> PERMiT CONDIT�ONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. <br /> 2. All work shell be performed in accordanc�with this permit and current City oi Everett Design and Construction <br /> Standards and Specificaf�ons. � <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREL NUMBER 1•800•424•5555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNO`NLEGGEMENT OF CONDITIONS �� <br /> (� The undersigned owner/applicant hereby a9rees to hold and save harm- <br /> '1� less the City ot Evarett trom any and all claims for damapes, cosis, <br /> � expenses, or cause� of action iha� may arise because ol installation <br /> B%��7 and mai,rienance ol lhe improvement or other right-ohway use hereto <br /> �I�,�'J applicd for and further agrees to remov� same upon notice irom the <br /> Approved for Constr � te Ciry and to replace public property damaged ihereby. <br /> a/ ,S-iF-f� �1 (�'� Qo.nr.. $ �.� �'-1 ' <br /> FINAL INSPECTION Date Tpate <br /> Approved as Construc•ed Si�nature of Applicant <br /> � WORK AUTHORIZED DY THIS PERfv11T MUST BE STARTED WITHIN <br /> evere[t PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS f0 <br /> � 3200 Cedar Streel 8E DILIGENTLY PURSUED TO COMPLETION.THIS PERMI'! MAY BE <br /> Everelt.WA 98201 CANCELLED bY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> ^hone: 259•8815 PROJECT OVER 90 GAYS DURATION. <br />