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, ��� ��(� <br /> Date�_�L4. / � � PubbC WorFs PErmil i �_ <br /> � i � ��. <br /> Bl�q.Depl + <br /> Application For � —T� <br /> PUBLIC WORKS PERMIT PWImWoiFSFeo 5 ---- <br /> Tolai Fee <br /> Le55 ApO� Fee Pm0 S <br /> Bapncc Ouc S <br /> ; Print or Type Only <br /> � SG3 — <br /> �UN1� � l�iP.�[FaV �dl�ax � lSD�-(_l= i�rnwa �_�'��{� 7a(D -o7a2S�S <br /> Owner —�ng Atldress Ciry�T Zip Phane <br /> �,�,� �loca I c����f �uo„ p��e� 35'3-dS3l� <br /> Appllcant Mailing Address Ciry Zip Phone <br /> Describe Proposed Work <br /> W <br /> Project Address(if known) � <br /> � Attach four�4)copies ol plans for proposed work- Draw lo scale and note the following as applicable: � <br /> � � P�operty Lmes • Centerline oi street � <br /> I • Outline and dimensions ol all existing and • Indicate Norih <br /> � proposeC structures on the lot • Show any proposed grading changes <br /> � � Ezisting and proposed uti�ities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> � 1.All cells for inspection shall be mede 24 hrs.in advance•phone 259•8810. � <br /> 2.All wo:k shall be performed in accordance with this permit and current City of Everett Design and Conslruction <br /> Stendards a�d Specilications. <br /> 3.Cell locetion Underground Service 48 hrs.hefore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> �i O <br /> ���G2 LCJG��2 �-�L.^i.�n.c j� ��� .�U���'7_0� � <br /> y � <br /> � �'-!'' . ♦A <br /> I ��/�j�U ��� <br /> � � O <br /> ; a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agiees to hold and save harm- <br /> � less the City ol Everett irom any and all claims for damages. costs. <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvemenl or other right-obwav use hereto <br /> applied lor and further agrees lo remove same upon notice irom the <br /> Approved tor Construction Date City and lo replace public property damaged thereby. <br /> FINAL INSPEC710N Date <br /> Approved as Constructed Si9nature ol Apphcanl Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM�T MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />