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� <br /> ��� : _ i <br /> y�!t Date� �. �� P„o�,�wo,�,P«� /' /P�/ <br /> F O�ng DeOt. �� _(_L-_ <br /> 1� ApplicaUon For r <br /> ��� PUBLIC WORKS PERMIT ��°^��°,°°°°°� -------- <br /> � ,o,.,,F�� a s_ <br /> � lessAnn�reepnio S <br /> Balance Duo S <br /> o�.�. Print or�ype Only <br /> Q11h..e11�� ��F11�"nl C YLkR I��� <br /> ;y� Ow er MaiNng Atld�ess Cily Zip Phone . <br /> ty M <br /> H <br /> H <br /> �p Applicanl Mailing Atldress Cily Lp Phone <br /> N EO Describe Proposed Work �5��'r I <br /> d GO / <br /> i <br /> W ' <br /> Proiect Address 1i1 known� C � <br /> Attach lour 141 copies ol plans br proposetl wo�k-Draw lo scale antl nole the tollowing as applicable: � � <br /> • Properly Lines • Centerline of street � <br /> • Outline and dimensions ot all e.isting and • Indicata North <br /> pwposetl structures on the lot • Show any proposed grading changes � <br /> • Ezisting and proposed utilities • Show measurements � <br /> 00 NOT WRITE BELOW THIS LINE O I' <br /> PERMIT CONDITIONS <br /> '�' 1.All calis ior Inspection shell be made 24 hrs.in advance•phane 259�881 O. � �.� � <br /> 2.All wo�k shell bx peAormed in accordence with this permit end current City of Everett Design end Conslruction <br /> ' ' Standards and Specificetlons. <br /> � 3.Cell Locatlon Undarground Service 48 hre.belore you dig.TOLL FREE NUMBER 1$00�424S55S. � <br /> 1'1 ' � � <br /> 1_� � <br /> 1 � <br /> � <br /> � <br /> 1 �/�9 � <br /> 'i a <br /> ►-i <br /> I�' ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save�arm• <br /> less the City ol Everr.it Irom any and all claims lor dameges, costs. <br /> '� expenses, or causes ol action that may arise because of installation <br /> _ antl maintenance ol Ihe improvement or other right�ol�way use hereto <br /> applied lor and further ag�ees to remove same upon notice Irom I�e <br /> -- -- Approved for Construction Date Ciry and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date ' <br /> Approved as Construcled Signalure ol Applicant Date ! <br /> i <br /> everett PUBLIC WORKS DEPARTMENT 'P/OFK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN i <br /> O 32ooCedarStreet i00 DAVS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS 70 <br /> Everett.WA 98201 8E DILIGENTLY PURSUED TO COMPLETION,THIS P[RMIT MAY BE <br /> Phone:259�8810 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. I <br /> I <br /> 1 <br />