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-� 1 I <br /> Date_ ^_ '_ „�:,,��•,o,�SN.� <br /> r <br /> G�nn Deo� + — ���— <br /> Applicalion For <br /> PU�LIC WORKS PERMIT °°°°°W°.�=`��-- - - <br /> To�:.l Fcc 5 <br /> less>npi Fce Paa1 5_. <br /> palancc Durt � <br /> Print or Type Only — <br /> ^ �� ' � �.�.U� <br /> IYIII'�� a�/n�'P � . /� �,�1��.L � <br /> O ner Mailmg Atldress City Zip Phone <br /> k u <br /> Applicant Mailing Address Cdy Zip Phone <br /> Describe Proposed Work ..Jr��� `�� <br /> -- W <br /> Project Addrr.ss(il known) � <br /> Attach lour(4)copies oi plans lor proposed work- Draw to scale antl note the following as applicable: � <br /> • Properry Llnes • Centerline ot street � <br /> • Outline and dimensions oi all existing and • Indicate North <br /> proposed structures on ihe lol • Sho�e any proposed grading changes <br /> • Existing and proposed utilities • Show measuremeNs � <br /> DO NOT 6NRITE BELOW THIS LINE O <br /> FERMiT CONDITIONS <br /> 1.AI!calis for insp3ction shall be maoe 24 hrs.in advance•phone 259-8810. � <br /> 2.all work shall be performed in accordance with this permit and current City of Everett Design and Constructior. <br /> Standards and Specifications. <br /> 3.Call Loc�tion Underground Service 46 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �oi ��!��� � <br /> �� ''i i��� H <br /> � <br /> 0 <br /> 0. <br /> ACKNONlLEDGEMENT OF CONDITIONS <br /> Tne undersigned owner/applicant hereby agrees�o hold and s•ave harm� <br /> less the Ci�y of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes ol action thal may arise because of installation <br /> and maintenance ot ihe improvemenl or other right-ol-way use hereto <br /> applied lor and luriher agrees to remove same upon notice irom �he <br /> Approved lor Construction ���e City and to replaca public properly damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol AppGcant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEO WITHIN <br /> eveiett PUBLICWORKSDEPARTM[NT 1g0 DAYS OF DATE PERhtIT IS ISSUED AND THEREAFTL"R IS TG <br /> � 3200Cedar5lreet BF DILIGENTLY PURSUED 70 COMPLETION.THIS PERAIIT MAY BE <br /> Everell,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK O�!THIS <br /> �hone:259�8870 PROJECT OVER 90 DAYS DURATION. <br /> ! ' <br />