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� � <br /> H <br /> � Hy <br /> H� � <br /> tt n <br /> � (~q� Date y"G �c `� �� Pu01ic Worws Permu• <br /> x x� Appliwtion For eiao oeo�.• 9a�.�YY9a <br /> [�J C 1 � <br /> o � e PUBLIC WORKS PERMIT PuUTolaFeo�ce $ <br /> .�.��g Lexs AOu��Fee Pa�a S <br /> �Y (] <br /> 9 y� Print or Type Gnly Ba�a�«o�a �; <br /> t•� <br /> H y , <br /> gey Ti`la/h�S F B /�i.dG �lYG �A.�au��eJ l�Lod ? SLo3 .� S�3-S�SC?f <br /> C Owner Mailing Address City Zip Phone <br /> � t' � <br /> HO[�i� "" � <br /> Applicant Mailing Address Cuy Lp Phone <br /> �� Describe Proposed Work !��-�� '� S� �' <br /> W <br /> Prolecl Address(il known) � <br /> Atlach tour(4)copies of plans lor propoSeA work• Draw to scale and note Ihe lollo•.ving as applicable: � <br /> • Property Lines • Centedine ol street /^ <br /> • Outline and dimensions ol all exisling and • Indicale North V� <br /> proposed slructures on the lot • Show any proposed�rading changes � <br /> • Existing and proposed utilities • Show measuremeNs � <br /> � <br /> DO NOT WRITE BELOW THIS LIN[ <br /> '' PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> '�' 2.All work shall be pedormed in accordance with Ihis permit and current Cily o�Evarelt Design and Constmction <br /> ' ' Standards and Specilicalions. <br /> � 3.Call Localion Underground Service 48 hrs.belore you dig.TOLL FRE[NUMBER 1•E300•424•5555. � <br /> 11 � <br /> 1_I II r,�� <br /> �� C_ W O�K-5 1'`l� �T �� �V I e�IJ � <br /> �, <br /> _I ��Wl.�(�o- O <br /> ►'1 s 8-� a <br /> ►_I Z-- <br /> '_' ACKNOWLEDGEMENT Of CONDITIONS <br /> The untlersi9ned owner/applicant hereby agrees to hold and save harm- <br /> � less Ihe Ciry ot Everett irom any and all claims lor dama9es, costs, <br /> expenses, or causes ol action ihat may arise because of inslallation <br /> and maintenance of the improvemenl or other ri�ht�of�way use hereto <br /> applied lor and Wrther a9rees to remove same upon notice irom the � <br /> Approved for Conslruction Dale Ciry and to replace puUlic property damayed ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construdetl Signature ol ApPlicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITfiIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet gE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA98201 CANCELLED BY THE CITY UPON�NY STOPPAGE OF NORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION, <br />