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/ <br /> /. ` i <br /> Date�"' 1 PUDI¢WOrFSPer ��/��� <br /> Application For dl�g Oept� ���—t;a;..�`-`--` <br /> PUBLIC WORKS PERMIT P�ieucWaiwsFee - <br /> .o�m F�e g---- <br /> 1e55 A001 Frtp Pdi4 5 <br /> 9alance0uu $ <br /> Z�'-- <br /> Print or Type Only <br /> C-�,rr�l� 1�hc�r�,, 1't� 3QX 11'�S �rc�' `'�� <br /> wner —����ng Address Cdy Zip Phone <br /> � � <br /> Applicant Mailing Address City Zio Phone <br /> Describe Propos.•d Work c 71—� . <br /> - W <br /> Prolect Address(if known) � � <br /> Attach four(41 copies of plans for proposed work- f��aw to scale and note Ihe follo�ving as applicahle: � <br /> • P�operty Lines • Centerline ot street � <br /> • Outline and dimensions ol all existing and • Indical� North <br /> proposed structures on Ihe lot • Show a��y proposed grading changes <br /> • Existmg and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with lhis permit and current City of Evaretl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL PREE NUMBER 1-800-424•5555. � <br /> O <br /> � <br /> � <br /> O I' <br /> a <br /> �9 ACKNOWLEDGEMENT OF CONDITIONS , <br /> /.1�� <br /> y — The undersigned owner/applicant hereby agrees�o hold and save harm- <br /> —'L less the Cily of Everett Irom any and all claims lor damages, costs. <br /> � expenses, or causes of action that may arise because ol installa�ion <br /> �I / !! �A�� � � I I_. �4 —'��C! and maintenance ut the improvement or other right�ul�way use hereto <br /> 'f(L�-�L-- PI � applied for and further agrees to remove same upon notice hom the <br /> Approved lor Construction Date Gity and replace puUlic properry damaged thereby. <br /> ��`� �� � - 3-�G �o`l' ,f4 <br /> :/�� � C�i 1 .2 ��i <br /> FINAL INSFECT(ON Date <br /> F.pproved as Constructed Signature ol Appficant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WOHKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � J200CedarStreet BE D�LIGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evcrett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJ[CT OVER 90 DAYS DURATION. <br /> 1 <br /> i <br />