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� <br /> , <br /> w <br /> --7 <br /> � <br /> t" �..�..�......_».�-H.. "'� <br /> __._ , , _ <br /> Date f S r�erewo�kero��.�. �— <br /> BICy.DeO�• � � �� 3���0 <br /> Application For <br /> �-•� PUBLIC WORKS PERMIT '°°;owFaaF°° s <br /> �ess noo�Fee r.�e S , <br /> ecianca oue S <br /> Print or Type Only <br /> �r21 E'� `1�ec��P�,e '�O� / iert�er? ��� <br /> pwner Mailing Addrass Crty 2iD Phone <br /> �`� ! l �P,y-�,J C�,o3T N�/- �G�'cJ /�Yl�. �c l�'e c 9�'J7J' �3�,s-�FJS�J.' <br /> Applicant Mailing Address City Zip Phone <br /> Desc�ibe Proposed Work ��J�� .--�'b0 � eN G l d��,�e <br /> W <br /> Prolect Address�il known� � � <br /> Attach four(4)copies of Olans lor proposed work-Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of ell existing and • Indicate North <br /> proposed structu�es on the lol • Show any proposed grading changes <br /> • ExistinB and prcposed utilities • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> i PERMIT CONDIT�ONS <br /> 1. All calls for inspection shall be made 24 hra in advance-phone 259•8815. � <br /> 2. All work shetl be pedormed in accordance with this permit and current Ciiy of Eveiett Design and Construction <br /> Standards and Speclfications. <br /> 3. Cell Locetion Undergruund Sorvice 48 hrs.belore you-:iig.TOLL FREE NUMBER 1-800-424•5555. � <br /> I No — �o��s 0 <br /> �.l, �-� �� ��'`� y F' <br /> �'�e �le� �/� �O ��J�—r•�, / �.� � <br /> � ��.n <br /> i <br /> /3 J�C7 � °2fCa �P�y`rt�� O <br /> s,�� o � �) a <br /> �� �� �e��-- <br /> s-� z � `y <br /> � ACY.NOWLEDGEMENT OF COND�TIONS <br /> The undersigned owner/applicant hereby agrees to hold and seve harm- <br /> less the City of Everett from any and all claims lor damages, costs, <br /> ezpenses, or causes ot acllon that may arise because ol installation <br />� I . . , and maintenance of the improvement or other righl-of-way use hereto <br /> applied tor and further agrees to remove same upon notice from the <br /> Approved for Conslruction � �a�e City and to replace pu6lic property damaged thereby. <br /> FINAL INSPECTION �a�e Date <br /> Approved as Constructed Signature ot Applicant <br /> everett PUBLIC WORKS DEPART N WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> � 320Q Cedar Street BE DiLIGENTLY PUR�UED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIiIS <br /> Phone: 259•8815 PROJECT OVEF 50 DAYS DURATION. <br /> l � <br />� <br />