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r <br /> Date_:y�� Puni�c worea Permn� '/ <br /> ' Application For e�eo.oec�.. �6 , � Y� <br /> PUBLIC WORKS PERMIT P°°°°W°�°,F°° : ` <br /> Totai Fee <br /> Lesa AoO�.Fee PaiE s I <br /> Print or Type Only ea�a�<e o�a s _ , <br /> i <br /> 0 <br /> Tl�l�lJ ilnnwt731/�LLJ # / �7E���� �)����Sxr� <br /> Owner Mailing Address Ciry LP Phone ; <br /> r <br /> ����'r�.���Pi u��cP�, ���'// s70 S—J•//•f SG� e�of�iD_D 9�Pn�� ���E��� <br /> G <br /> Applicant �Mailing Address City ZiP Phone <br /> / �G1 __/ /� <br /> Describe Proposed Work � �1�J�-���2��`���'u�—� J/n'�rZ <br /> ( <br /> i <br /> I <br /> _ � � <br /> Proiect Address(if known) � ~ <br /> Attach tour(4)copies of plans lor proposed work• Draw to scale and note the lollow ng as applicable: � <br /> • Property Lines • Centerline ot streel /� <br /> • Outline and dimensions of ali existing and • Indicate North V� f <br /> proposed structures on the lot • Show any proposed grading changes f <br /> • Existing and proposed utilities • Show measurements �A <br /> W <br /> DO NOT WRITE BELOIN THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for i�spection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Constructiun <br /> Slandards and Specificatione � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � I <br /> � <br /> PuGI�� Ctlw�s y�e, �r �/ �a� �pa�� y/��e/�'l � <br /> ,�,�,� �-- <br /> ��� ���� � <br /> � <br /> L3. <br /> ACKNOWLEGGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everelt trom any and all claims for damages. costs, <br /> expenses, or causes of action that may arise because ol installation <br /> � and maintenance ol the improvement or other right-of-way use hereto <br /> applied fof and further agrees to remove Same upon notiCe from ihe <br /> Approved lor Construciion Date Ciry and to replace public properry damaged thereby. <br /> FINAL INSPEC710N Date — — <br /> Approved as Constructed Signature ol Applicant Date <br /> WOFK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> e�� PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> EveretC WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�. 259�8815 <br />