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Date� v � — �" P,�n����vo...�o,m�� I _�-1I <br /> �I�9.De�l � �-I�LT-��_' <br /> ApPliw�ion For _...___ <br /> PUBLIC WOF�KS PERMIT PubTo�F�e��� 5 <br /> lessApOi FeePnA S — <br /> Lnlnnrr[lur � <br /> Print or Type Only <br /> �ni-rti n�vL")t�' <br /> Owner <br /> pAading Address Cily 7_ip Phone <br /> qpplicant <br /> Mai6ng Atldress Gty Zin Phc ie <br /> Describe Proposed Wnrk _ <br /> �T-�( I�,��I�L � �6'�'1E'Y(C°/�� <br /> W <br /> Prolect Address lit knowN �� �� C' / � <br /> � <br /> Attach four(4)copies of plans lor proposed work- Draw to scale anr note;he lollowing as applicable: � <br /> � property Lines • Centerlina ol sireet <br /> • Outline and dimensions ol all enisting and • Indicate North <br /> proposed structures on ihe��1 • Show any proposed grading changes <br /> • Exis�ing and proposed utilitics • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls tor inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work ahall be pertormed in accordance with this permit and current Cily of Everett Design and Construction <br /> Standards and Specifica�ions � <br /> 3.Call Location Underground S�rvice 48 hrs.6efore you dig.TOLL FREE NUMBER 1•S00•424•5555. <br /> ru�r �� . O <br /> ������:- F- <br /> �,��� N <br /> O <br /> a <br /> �CKNOWLcDGEW`r.NT OF CONDITIONS <br /> Tha undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Cily ol Everelt Irom any and all claims tor damages. costs. <br /> ezpenses. or causes of action that may anse 6ecause ol installation <br /> and mainlenance of the Improvement or olher right•ol-way use hereto <br /> applied for and lurther a9rees to remove same upon notice irom the <br /> Appiova! ���r Conslruction ���� Cily and to replace public properry damaged thereby. <br /> FIHAL INSPECTION ��1e Date <br /> Ap�roved as Conslructed Si9nature ol AppGcant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PEfiMIT IS ISSUED AND THEREAF7ER IS TO <br /> � 32QOCedarStreet BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />