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� v � � / <br /> Date��j_ <br /> Pu01.c 1vo��.s Perm�t. ___�� <br /> Applicatio$or B�aa �e�+ • __ <br /> PUBLIC WOR�S PERMIT PUUbcWo��siea — ['.�- <br /> � Total Fee S <br /> ples5 ROP� �nc PdrC S��� <br /> � O O palance 7ue S •�- V <br /> Print or Type Only � <br /> vi o 0 <br /> r i v� v� <br /> � <br /> w w <br /> i • - > , i.�r "� <br /> �- . ' - �� � �i /� �i -� r- rl �> � _� l ' F ;, %T � -';'r,�.; �7,��.-.. . � 1.�," <br /> Owner MadingAdd�+s�': = CitY ZiP Phonr. <br /> rv o �- ¢ <br /> � � ti a o � <br /> 'FI tsrQ ` ' � . � - <br /> f3 „ F . ,,, -�� , � ��_, � ; <br /> Applicant Mailing Address Cdy I, , -_-- � —`�— <br /> � Phonn <br /> Describe Proposed Work �L__^ �%�r' 1 �� �� � . ' <br /> Prolect AdJwss Id known) ���V7/L N ; !� � / C. �i7��,�� � <br /> Attach four(4� copies ol plans lor proposed work- Draw to scale and nole the lollowing as applicable: � <br /> • Property Lines • CeNerline of s�reet � <br /> • Outline and dimensions of all exis6ng antl • Indicale Norih <br /> proposetl struc�ures on�he lol • Show any proposed c�raAing change; <br /> • Ezisting and prOposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LIN[ <br /> PERMIT CONDITIONS O <br /> t.All calls lor inspection shall be nade 24 hrs.in advance� phone 259-881 Q � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Desi�n:�nd Corsiruction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> ,�c�>,('.r �:2� - _ �. _ — <br /> . � � -'��C�G . /� .�- �_- - i �" c ��'%1� 'i D' � <br /> �`?1� !�/.E'f-� -�� - O <br /> �=� ,�.%S�i' .,�z�S/�' � �. '�x=, <br /> � <br /> � <br /> O <br /> � <br /> �CKNOWLEf�GLM[NT OF CONDITIONS <br /> -- _______ _ ihi�undeisignod o�encUapplicanl hereUy agiee5 to hold antl save harm- <br /> -- less the Cdy ul Eveiett liom any and ali daims lor damages. cosis. <br /> ---���� �-������ expenses, or causes of aclion ihat may arise ber,ause ol installa�lon <br /> � � �_ - "���_ . � and maintenance of ihe impiovement or other �ighhol�way use herelo <br /> Appi�vr,d for Co s c� Date aPNied lor and lurlher agrees to remove same uPon notir,e Irom ihe <br /> City and to replace pubhc property damaged ihcreby. <br /> �z� �.� <br /> FINAL INSPECTION p�1e - � <br /> �PP�oved as Consiructed Signatwe of AppfiCant � - � ��\;'� Date <br /> ivrr�ll PUBLIC WORKSDEPARTMENT WORI( AUTHORI2[D BY THIS PERMIT N1UST BE STAFTED WITHIN <br /> � 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSI"'^ AND THEREAFTER IS TO <br /> Everetl,WAgg201 BE DILIGENTLY PUFSUED TO COMPLtfICN. THIS PERMIT MAY BE <br /> Phone.259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />