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� �� <br /> m � x <br /> � y � � <br /> ��� Date�l�/ PuoiroWa�waPer •:` �U� ` <br /> 0 ''I'' 0 Bioa,DePt+ � 7 <br /> � y H Application For � <br /> PUBLIC WORKS PERMIT Pueiicworhsiee <br /> � � � Totnl Fee $ <br /> � rJ Lesf ADC��Fea Paip � <br /> Balance0ue � �"�'� <br /> ��� Print or Type Only <br /> � H� � � ��i,n �'�� / �x �/8S� �r>Yt�'� 9 S'�'�3 <�1��7�37i� <br /> gy H Owner � Mailing Address City Zip Phone <br /> ��N �I <br /> l� <br /> y� Applicant Mailing Address City Zip Phone <br /> HOf/� `�.,� <br /> DescribeProposedWoik ��-`�� ^ '— <br /> - - W <br /> I co I 0 � �,�.��� Avc= � <br /> Proiect Address 1i1 known) �, <br /> Attach four(4)copies oi plans lor proposed work-Diaw to scale and note the lollowing as applicable: � <br /> • Properly Lines • Centerline ol street ♦A <br /> • Outline and dimensions of all existing and • Intliwle Norih V I� <br /> proposetl structures on�he bt • Show any proposed 9radmc�chanc�es <br /> • Exisling:�nd proposed utililies • Show measurements /�/� <br /> W <br /> ��� DO NOT WRITE BELOW THIS LINE <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 pedormed in accordance with this permit and current City ol Everett Design and Conslmctlon �/ <br /> '�'1 Standams and Specifications. <br /> 3.Call Locelion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> ��' � <br /> 1 O <br /> ' � � t Fp, � }1�� � <br /> 1` i A' ' <br /> �-� � � <br /> � � �.,. `��-..` O <br /> { �.., , _ . <br /> _ � .;� <br /> � �`� � a <br /> '_' £FFy � . .. .. <br /> � �.,v <br /> � ��� • � <br /> ��F„ <br /> 1 1 � ACKNOWLEDGEMENTOFCONDITIONS <br /> _' The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less Ihe Ciry of Everett Irom any and all claims lor damages, cosis. <br /> ._ _. ezpenses, or causes of action ihat may arise because ol installation <br /> _(,�`c � �n�� � ��� c�`� and maintenance oi ihe improvement or other righbol�way uso hereto <br /> I J applied for and (urther agrees lo remove same upon nolice Irom Ihe <br /> Approved fo�uclion � Da e Cily and to replace public property damaged ihereby. <br /> �`���/-3 '%/ . �.� /,? � .� <br /> FINAL INSPECTION Date � Datc <br /> Appmved as Conslruc�ed —8 9nalu�a ppticant <br /> WORK AUTHORI2ED BY TH�S PERMIT MUST BE STARTED WITHIN <br /> everetl PUBLICWORKSDEPARTMENT 1B0 DAYS OF Dl.TE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT h1AY BE <br /> Everetl,WA�JB201 CANC[LLED BY THE CITI'UPON ANY STOPPAGE OF WORK ON Th115 <br /> Phone:259�8870 PRO.IEGT OVER 90 DAYS DURATION. <br />