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Date�J PubLcWorksPurmlla ��`—'����/ <br /> Application For Blag.Deo�.• �L�r.� / Q� <br /> PiJBLIC WC)RFCS PERMIT P°°�°W°,�BFeB <br /> Total Fee $ <br /> LessAp0l.Fea>aitl u <br /> Print Of lype Only ea�a�ceo�a s 2L� 00 <br /> ���8� <br /> �Ii-� -_: rc� �L�/ Tr3,�;, -"�� : � .+�ic3 "'`r7 - i�,- � <br /> Owner ` M.iilingAddress City Zip Phone <br /> , ii; ' ._ , l ;t� �i ;.i � �7 - /;, <br /> � Applicant Mailing Address City � Zip Phone <br /> Describe Proposed Work � 'i i, ' � �� Ir ' � ��/L��'%_. . � LciG,e,� SHdY' <br /> _ _ _- - W <br /> P:oject Address(if known) Q . __ � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note tha fcllowinc7 as applicable: o <br /> Y Property Lines • Centedine d slreet /A <br /> • Outline and dimerions o�all existing and • Indicate North V� <br /> propOsed struc!ures on the lot • Show any prepcsed grading changes <br /> • Existing and prop�sed utilities • Show measurements � <br /> �a� <br /> DO NOT WRITE BELOW THIS LiNE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor in;per,tion shal� be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in 2ccordance with this permit and current City of Everett Design and Construction <br /> Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. betere you dig.TOLL FREE NUMBER 1-800•424-5555. W <br /> ` <br /> O <br /> � <br /> � <br /> O <br /> O <br /> ACKNOWLEDGEMEIJ7'OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> — - less the City of Everett irom any and all claims (or damages, costs, <br /> � expenses, cr causes of action that may arise because of ins�allation <br /> c A ���1 J�a_b�J and maintenance of ihe improveme•d or other right-ohway use hereto <br /> Ap?roved fur Construc ion Date appl'ed for and furiher agrees b remove same upon no�ice from the <br /> . City and to replace public property dama9ed thereby. <br /> FINAL INSPECTION Date ' ����� � I7 �5� <br /> Appruved as Cunslrur:teo Signatur of Apt�licant � � Date <br /> everett PUBLIC WORKS DEPAR MENT WORK AUTHORIZED BY THIS PERMIT MUST SE STAR?ED WITHIN <br /> � 3200CedarStreet 180 DA1'S OF DATE PERMIT IS ISSUEJ AND THEREAFTER IS TO <br /> Everet;, WA 98201 BE DILIGENTLY PURSUED TO COMPLE.TION.THIS PERMIT MAY �E <br /> � Pt� ;�c: 2'9-9f31 5 GANCELL[D oY THE CITY UPON 4NY STOPPAGE OF WORK ON 7HI9 <br /> IPROJFCT OVcR ?0 U�YS DURAT�.ON. <br />