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1 V� P��OIm VJarks Veimil a � <br /> Date�� U �-�.���� <br /> Application For emq.o�oi�_ <br /> PUBLIC WORKS PERMIT PU�To�Fce��� 5 <br /> Less FOP��Fee Paid $ <br /> exlanca Duo 5 <br /> Print or Type Only <br /> ! � �I �� �� T�n1S , q�i � 5C �L�`� p�=� Ts� , �l� <br /> Owner Mailing Address City Zip Phone <br /> ��T YY,NI� i�P � �3C, -��I .3 <br /> Applicant Mailing Address City Zip � Phone <br /> Describe Proposed Work ��2Ly� y �� - <br /> W <br /> Prolect Address(it known) � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note ihe following as applicable: � <br /> • Prop�rty Lines . • Centerline of streel ♦A <br /> • Outline and dimensions o(all exisfing and • Indicate North V� <br /> proposed struclures on ihe lot • Show any proposed grading changes <br /> • Existing antl proposed utili�ies O Show measuremeMs /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 7. All calls tor inspection 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 Evere�t Design and Construction ♦ <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 46 hrs. before you dig.TOLL FREE NUMBER 1•800-424-5$55. � <br /> J� r o <br /> l" LJc� GiC` Gcic'%i�,(S� �`Z�i��i% /�/07- ��FG�U,r�'E1� � <br /> IO�j� -> N <br /> � , <br /> �� � <br /> � <br /> ACKNOWLEDGEM[NT OP CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Ciry of Everett irom any and all claims for damages, costs, <br /> expenses, or causes of aclion that may ar�se because of installation <br /> and maintenance of the improvement or other ri9ht-ol�way use hereto <br /> applied for ar.d Iwther agrees lo remove sane upon notice from the <br /> Approved for Construction Date City and to replace public property damaged �herrby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalure of Applicant ��« <br /> ����i�� PU2LIC WORKS DEPARTMENT WORK AUTHORIZEfI BY THIS PERMIT MUST BE STARTED VJITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF' IS TO <br /> � 3200 CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFF.".IT MAY BE <br /> Everett,`NA 98201 CANCELLED BY THE CITY UPON ANY STOPPAG[OF\h'ORP:ON THIS <br /> Phone: 259�Hf375 PROJECT OVER 90 DAYS DURATIOtJ. <br />