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_ _. <br /> Pubecl'fn�MSPsrmit• /� __.._ <br /> Date�.� eiae o�oi.. ���Q�nZa��Y!(�--- <br /> Application For <br /> PUBLIC WORKS PERMIT P°°TowFep�ee g ---- <br /> LessAno� FeePaN S — <br /> palanr.eDue g <br /> Print or Type Only <br /> �PA p L'bbuliC �a� �OrIAViAUJ EVP/E1�" 1n8oZCl� 353- 59�l4 <br /> Owner Mailmg Address City Zip Phone <br /> �- Mailing Address Ciry Zip Phone <br /> Applicant <br /> Describe Proposed Work CbN ✓Pr�� e- ��RrQ� - <br /> W <br /> Proiect Address�il known) ���--S�V� ��� - ~ <br /> Attach tour(41 copies of plans for proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions of all ezisting and • Indicale North <br /> proposed slructures on the lol • Show any proposed grading changes <br /> • Existing and proposed utiGties • Show measuremeMs � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspeclion shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Conslruction <br /> Standards and Specificetions. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> i <br /> I �1 / � <br /> � �LC �Gc' l 'D��C �7? I Il '����fr[`L2« > / <br /> c L c�7»it- t• �c- • ,�� <br /> t ��I�7C z"1�� <br /> G--7G—:��i � <br /> � <br /> � <br /> a <br /> ACKNOWLFDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant heieby ag�ees to hold and save harm• <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> ezpenses. or causes of action that may arise because of installation <br /> and maintenance ol the improvement or other righbol-way use hereto <br /> applied lor and further agrees to remove same upon no�ice irom the <br /> Approved lor Construction Date City and to replace public properry damaged thereby. <br /> FINAL INSPECTION Dale Date <br /> Approved as Construcled SignaWre ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARiMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200CedarSireel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EvereU,WA 99201 CANCELLED BY 1HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />