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/' Date��CZ� PubLc 14Jds P�. 8���� <br /> Applica�ion Fot eiae�Dooi�+ <br /> RUBLIC WORK� f'ERMIT 7uETc�„Fk�s�Fee s <br /> Less AOo�Fee Pald g <br /> Beian<e Duo $ 2�00, <br /> Print or Type Unly <br /> [��n i� I �ill,4u,� 1 ��� �sz �2r�-+r,11_1�v� �S155 �,�-�?��� <br /> Owner ailing Address Ciry Zip Phone <br /> p`� Pp�i�y�� Mailing Address City �ip Phone <br /> Deac�ibe Proposed Worh ___I_�AAI .� <br /> r W <br /> Project Address(it known) �/�Q 7 ` G DUE��R L� � <br /> Attech lour(4)copies of plens for proposed work• Oraw t�scaie and note lhe lollowing as applicable: � �, <br /> • Property Lirtes � Centerline of street <br /> � ��tline and di�nensions of all existing and • Indicate North � �i <br />� proposed sti�ctures on the bt • Show any proposed gradinc�changes <br />. • Ezisting ard proposed utilities • Show mr.asuremeNs � II <br /> DO NOT WRITE BELOW THIS LINE O <br />�, PERMITCONDITIONS <br />� 1. All calls for InsVection shall be m:�de 24 hrs in advance• phone 259-881 5. � <br />!� 2. All work shali be peAormed in a_c.ordance with this aermit and current Ciry of Emrelt Design and Construclion <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-500•424-5555. � <br /> O <br /> i � <br /> � <br /> , O <br />, a <br />� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> CK�� 7he undersigned owner/applicanl hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims !or damages, costs, <br /> expenses, or causes ol aclion that may arise because oi installation <br /> I � /J / 2 ��7 nnd mainlenance of the imprcvement or olher right-ol-way use hereto <br /> Bof'h— �o applied for further agrees to remove same upon notice Irom tha <br />, Approved lor Con, r �� Date City and lace public property J, aged thereby. <br /> 3-�/-� '� � _(� <br />` FINAL INSPECTION Dale <br />� Approved as Constructed Sig re o pp icant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK A HORIZED BY THI:; PFRMIT MUST BE STARTED WITHIN <br /> 180 DAV OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br />� 3200 Cedar Street BE DILIGENTLY PURSUED TO �OMPLETION.THIS PERMIT MAY BE <br /> Eve�elt.WA 98201 CANCELLED BY TIiE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />, Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />