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/ 7—�� /�,p�, �� a n^ <br /> Date y" �„��,�wo,�t�,.,,,, . <br /> Application For emA Deo�.. ._ ..___ _ __ ___ _ <br /> PUBLIC WORKS PERMIT � LiotaiceFea � -- <br /> lessAnol fRrPqN � �_ <br /> Print or Type Only oa�a�=� o�� s _ <br /> 0�5�- �f/G, 7 <br /> �Q�.,,. . GLf � «N�.P ,. s ��/S �raHd �G�e �t�eve� //,i. `�1b'�/ <br /> pwner Mading Address Cny 7ip Phone <br /> ��tt� /� So�ti�<v5 — .14wi � — <br /> Apphcant Maihng Address City Lp Phone <br /> Descnbe Pro`p/osed Work ��«un T Q ��mat f ��! rL� I�etU P ' 1 r.r S fo�� r�o��C '— <br /> 7ti S7411_ I�ht�Ufii�ei u Ae r�s s 5.'�0 �.�.�,E . <br /> 0 W <br /> Pro�ect Address lil knowrd —�i�w.�Q _ � <br /> Attath low�4�copies ol pl�ns lor proposed work- Draw lo scale and notr,ihe foltr Ning as apPlicaUle: � <br /> • Properry Lines • Centerhne ol street � <br /> • Outlme and dim=nsions oi all ea�stinc�and • Indicate North <br /> proposetl structures on ihe lol • Show any proUosed grading changes <br /> • Ezist�ng and proposed utiltlies • Show measurements � <br /> DO NOT WRITE 9ELOW THIS LINE O <br /> PFRMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•881 U. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ol Everetl Design and Construction <br /> StanAards and Specifiwtions. <br /> 3.Call Location Underground Service 48 hrs.befure you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> � <br /> O <br /> . � ��, � � � <br /> , �•� � � � � <br /> „ , 0; �" ; n� <br /> � � �' � �` p, <br /> ACKNOWLEDGENENT OF CONDITIONS <br /> 7he unders9ned owner/applicant hereby agrees to hold and save haim- <br /> -- less Ihn Cdy ol Everett Irom any and all claims lor tlamages. costs, <br /> expense= or causes ol action Ihat may anse because ol installation <br /> and mamtenance ol the improvement or other nghPof-way use hereto <br /> applied lor anc further agrees to remove same upon notice irom the <br /> Approved lor Consiruction Date City and to replace public property tlamaged thereby. <br /> FINAL INSF'ECTION Date _ <br /> Approved as Construcled , Si9nature ol Applicant Date <br /> evere�l PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel i80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS i0 <br /> Everetl,WA9B201 B[ DILIGBNTLY PURSUED TO GOMPLETION. THIS PERM1IIT 61AY BE <br /> Phone:259�8810 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />