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Date3 9 �% Pu01ic WorW Pormlt r _ — <br /> Application For BiEg.Dept.• <br /> � PUBLIC WORKS PERMIT <br /> Public Worka Feo S <br /> Tolal Foe <br /> Leaa ApG�Fee PniO S <br /> eeiavice ouo S .VO CN9.C�E <br /> Print or Type Only <br /> , ' (n�4.f�ceY `fo8' Pcr�c ('(aee Euev�-7�` <br /> pW�E, Mai�ingAddress Ciry 2ip Phone i <br /> I <br /> Corvsrtzucr��u /�ss�s�' zrno9 �C�� s.E �.5'o�7`(Te (/ 9�'t7?( 48(— /c'9z ( <br /> Applicant Meiling Address Cily Zip Phone <br /> Describe Proposed Work T.v sr9ac:- ��/�c- T� �il'� �-�" L ��—E� I <br /> ��UyJ �G"�OTiN' l�i��•Airf/ �iPOL'�/J FUt/.[!!.]5'i/O�✓ � <br /> I <br /> 1,,/ W <br /> Proiect Address(it known) 7 Ua r`!��� ��aC ���e� r'�� � <br /> At�ach four(4)copies of plans lor proposed work• Draw to scale and note the following as appticable: � <br /> • Property Lines . • Centerline of street � <br /> • Uutline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilitios • Show measurements M <br /> W <br /> DO NOT WRITE BE-LOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All c�lls for inspection shall be niade 24 hrs in advance•phone 259•881$. � <br /> 2. All work shall Ce performed in accordance with this permit and current City oF Everett Design and ConsVuction <br /> Standards and Specilications <br /> 3. Call Locatir��Underground Service d8 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � <br /> /�if.�C.�' OCl% fQf/�NlJLT �'Li,E,B �' 1NSTACL f//`�E O <br /> ,ff,tl0 .c EIN5:9CL Ccc2'D .97 S%.?EET, � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of aclion ihat may arise because of installation <br /> /� � � and maintenance ot the improvement or other right-obway use hereto <br /> C�� '�j /„YJc��-=_ .3/C/n'7 applied for and fuAher agrees to remove same upon notice Irom the <br /> Approved for Construct" n ��e City and to replace public properry damaged thereby. <br /> FINAL INSPECTION �� I Dat� ��–�'�t � �y'�/� �IU�-� <br /> ApProved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPAFTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT 1�1AY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE GF WOfiK ON 7HIS <br /> Phone: 259-6015 PROJECT OVER 90 DAYS DURATION. <br />