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� <br /> � <br /> � 7 - 7 .. <br />' �$te��_�/ Public Waiks Parmil r �/ � r�� <br /> Application For �iee�oem.. -- ' <br /> PUBLIC W�RKS PERMIT. °°°to,eFe„`eB : — <br /> LesS Appl Fae�altl $ <br /> Print or Type Only Ba�a��oo�9 i� � C�� <br /> tia,�,oy� � <br /> �_,�-B� �,s-�-�'�� <br /> _��c,�� �FGCE l�l�'/�Uc�ER_EUE�s'c=11 ,Q�F.?t�/ .'tS9' y35� <br /> Owner Mailing Address City Zip Phone <br /> � � . . _._ . _._ . _ _. . ._......... .... _ ----_ __. <br /> Applicant Mailing Address City Zip Pho:9 <br /> Descrihe Proposed Work .f-/" �-�—' ��� S_��'��'--`�'� a�( <br /> �� �L�.•� <br /> 'G ��� mo TN o � t./� SF�oTS <br /> W <br /> Project Address(if known) �a C�E y1l6'R."-_. �E/cc/LTS' �IJT / -'� � <br /> Attech(our(4)copies of plans for proposed work-Draw to scale and note the fol�owing as applicable: '�41ie• � <br /> • Property Lines • Centrrline of strcct __—_ _- --_ ________— -- <br /> • Outline end dimensions of all existin`g and �� • Indicate North �'�� " """ " " �"""' ' �� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Sh.ow measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CON!)ITIONS <br /> 1. Ail cells for inspection shall b?made 24 hrs in advance- phone 259•881 5. � <br /> 2. A�I work sh,all be perfnrmed in eccordance-with this permit and current City of Everett Design and Construction <br /> Standards and Speciticationa <br /> 3. Call Locet:on Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> LoT is' .�o. Tv ,dE �.�.cr-v� �,� F�F�%�s�r.n.L� O <br /> '"' <br /> � <br /> 0 <br /> a. <br /> � ACKNOWLEDGEMF.NT OF CONDITIONS <br />� The undersigned owner/appiicant hereby agrees to hold and save harm• <br /> less the City of Everett from any and all claims for damages, costs, <br /> � expenses, or causes of action that may arise because of instaltatiun <br /> �� 7 and maintenance of the improvement or other right•ol-way use nereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved lor Const ction Date Cily and to replace public property damaged thereby. <br /> � ���f`, ' <br /> FINA INSPECTION ' Date <br /> Approved as Constructed � Slgnature of pplicant Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 8Y THIS PERMI MUST 9E STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br /> Eve�ett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS FERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY 7fiE CITY�iPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJECT UVER 90 DAYS DURATIqN. <br />