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PuClic Works Permit• ✓��� <br /> Date/�iC�7 � � ema.oeu�.+ <br /> Application For <br /> PUBLIC WORKS PERMIT Publit\YorhsFae <br /> To1a1 Feo s�� <br /> Lass APP�Fee Pa10 $� <br /> eniance Due S <br /> Print or Type Only � .110 C.i�A•eG� <br /> - ��,�.�9.�y�,�,o - <br /> �n .�� ��t-LLE � 7l l �D6r n�de�rz [..a,v� �'U�-�p�Tl <br /> �s Loc.�Tla,v CiIY ZIP Phone <br /> Owner '' <br /> �R�Yr���= ���.�9 � �F��-n 98ao/ aS9-ti39.2 <br /> Phone <br /> Applicer.� Mailin9Add�css City Lp WGWk" �5�'�"L`�� <br />� Descrlbe Pioposed Work ��J�T�"LG Rc�cK F/��� <br /> �ico,v� i-.ev,�r oF /�'�vp�.v rU <br /> '� � ,(3,q Fit'�sr. G=D c�C of' Sl.L>r GJi�L.�� /�t R �t-rr.a �.�r.F�— <br /> W <br /> Proled Address(if known) �� �' � <br /> ��� - ��i� E G.� ao � .�,v�- I"" <br /> � <br /> Attach tour(4)copies of plans for proposed work• Draw to scale and�ote ihe following as applicable: � <br /> • PropertY Lioes . • Centerline of street <br /> • Outline end dimensions of all oxisting and • Indicate North <br /> proposed structures on ihe lol • Show any proposed grading chan9es � <br /> • Existing and proposed utilitio,s <br /> • Show measurements <br /> t ODO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in edvance-phone 259•881 5. <br /> 2. All work shall be performed in accordanco with lhis permit and current City of Everell Uesign and Construction <br /> Standerds end Specificationa � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER t 800•424-5555. <br /> Co,r,Err,�vc:- i�,�,�� �i fi �5;.�,✓n.-n,�v �.�2f� �/,a.Tif'cf�Eo) <br /> 0 <br /> � <br /> � <br /> 0 <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicent hereby agrees to hoid and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> � exf•enses, or causes o1 action that may arise because of installation <br /> n antl maintenance ol the improvement or other right-ot�wey use hereto <br /> „� . Ovf� applied for and further agrees lo remove same upon notice trom the <br /> Approved for Construction Dal City and to replace public property damag�Q�}eby�r <br /> �20�, `{ell� 4-a4-fr� <br /> Date � � � � Dete <br /> FINAI. INSPECTION Signature ol Appli nt <br /> Approved as Constructed <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED W HI <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUFD TO COMPLETION.THIS PERMIT MAY BE <br /> F_verett,WA 98201 CANCELLED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. <br />