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Date1_L� �� <br /> , • .�,.:;: . � r„ei�c wm�.s r��mn. }'7�� 7 <br /> � � � AnPlica�'en For � �����o�ci.. �e��/���n <br /> � y y PUB�LIC WORKS PERMIT �,����<<��«,��a ------ . — <br /> �S totei rrr S__ <br /> H 7 '2 <br /> y L M tessnno� �ec ca�e S_ <br /> o m o Print or Type Only c,�.,�.:�o�� s__ <br /> '47 H �4 -- <br /> N M <br /> o � � �v ��, ►an� �i�--c�l �ve �� .�retf a� i ���� r,�-1��1 <br /> p n d M�1 ng Atltlress Ciry Zip Phone <br /> � :° R i2 �; <br /> z r+ �S <br /> � M y Applican�, Mailmq Adtlress City Zip Phone � <br /> N � <br /> G " �-f�`�I F� `� t?�17 <br /> N Descri6e Proposetl Work _ <br /> � �y t0 <br /> O y <br /> N <br /> P�oleCt Adtlress l�l knownl I�! J / ( ' �1�� �1 /� W <br /> Attach lour�4)copies ol plans for proposed work- Draw to sr.nle and note the lollowine�as applicable�. <br /> � <br /> • Property Lines � <br /> • Outline and dimensions of all existin anA • Centerline ol street � <br /> 9 • Inditale Norih <br /> proposetl siructur=5 on Ihe Io1 • Show any prJpoSed grading chanyes <br /> • Existing antl proposed utihtie5 • Show measurement5 <br /> DO NOT WRITE BEIOW THIS LINE �/ <br /> PERMITCONDITIONS O <br /> � � �� � 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8$10. <br /> � �' 2.All work shall be peAormed in accordance with Ihis permit antl curren�City ol Everett Design and Construction � <br /> � Standartls and Specilications. <br /> . . 3.Call Location Undergmund Service 48 hrs.before you dig.TOLL FREE NUMBER 1•$00•424•5555. <br /> � �—� Z <br /> '' O <br /> I __ I- <br /> -- �.�� � ����,, ;-, �� . ,- � <br /> � O� �_ ����...� �� � �-� � <br /> � a <br /> � �, . ,�.. _ � . �i <br /> J f�!i <br /> I �1 ' ACKNOWLEDGEMENT OF CONDITIONS <br /> I The undersigned owner/applicant hereby agrees to hottl and save harm� <br /> � less Ihe Qly ol Everetl Irom any antl all claims lor A�mages, cosis. <br /> ��r� expens•.•s, cr causes of action Ihat may arise becu�.se of installation <br /> . and maintenance ol Ihe improvement or other ric7hPol-way use hereto <br /> APPwved lor Construdion Date applieA lor and lurthcr agrees lo remove same upon notice Iwm the <br /> � City and to replace pubGc pwperty dama�ed Ihereby. <br /> FINAL INSPECTION p��i; <br /> Approved as Ccnstructed Signalure ol Applmant <br /> Date <br /> evereit PUBLIC WORKS DEPARTMENT N,�ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phonc:259�8810 CANCELLEG BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJ[CT OVGR 90 DAYS DURATION. <br />