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1-1��'I '�' �-� <br /> Date ��,�,,,��.��..s P.,.�,�• <br /> ein9 oro� . _S.�_l—r�L!�� <br /> Application For <br /> PUBLIC WORKS PERMIT P �1oWFee`eO g- <br /> 1055 ApPI.F!C PPN `S-- <br /> Calance Ouc s <br /> Pri�t or Type Only <br /> ^ F' ���^�.�a%�.�r; ,�I'� I'�_��-� �-�_,�- �-��0'� <br /> pN,�e1 Maihng Address City T n Phone <br /> Apphcant Malling Address Cily Zip Phone <br /> Destrihe Proposed Work ����� <br /> " � - W <br /> Project Address lil knownl � ` `�� ���— � <br /> Attach lour(4) copies ol plans lor proposed work� Draw to scale antl note the lollowing as apPlicable: � <br /> • Property Lines • Centerline ol street <br /> • Outline and dimensions ol all existing ard • Indicate Norlh <br /> proposed strudures on the lo� • Show any proposed grading changes <br /> • E■isting and proposed Wilities • Show measurements M <br /> W <br /> .' DO NOT WRITE BEIOW THIS LWE O <br /> i <br /> � PERMIT CONDITIONS <br /> ' 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> �� 2.All work shall be penormed in accordance with:nis permit and current City of Everett Design and Construction <br /> ; Standards end Specifications. <br /> 3.Call Locetion Underground Service 48 hrs.before you�'ig.TOLL FREE NUMBER 1•SOO•424•55�55. � <br /> 1 � O <br /> � � � i <br /> . / /� t�. � '��-��. �� � . r �ili.� �-C ' �( <br /> �f; �lc r, � _ �- �'/•�, - <br /> . �� i. � T'�. ��— <br /> �� �f j%-'>'.� � <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF GONDITIONS <br /> The undersigned owner/applicant he�eby agrees to hold and save harm- <br /> less the City of Everetl I�om any and all claims lor damages, cosls. <br /> expenses, or causes ol action that may arise because ol installation <br /> and maintenance ol th�: �mprovement or othcr nght-ol•way use hereto <br /> applied for and lurthe: agrees to remove same upon notice from the <br /> Approved lor Construction ��� Cily and to replace public properly damaged �hereby. <br /> FINAL INSPECTION Dale Date <br /> Approved as Constructed Si9nature ol Applicant <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA98201 CANCELL[D BY THE G7Y UPON ANY�TOPPAGE OF WORK ON 7HIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />