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} <br /> Date� � � Public Warka Pormll a '��2�/ <br /> Bloq.Deo�.+ <br /> qpplicetion For <br /> PUBLIC WORKS PERMIT PuOTo�FeeFee s <br /> Less Aoo�Fee PaiO S <br /> Balance Due s <br /> Print or Type Only <br /> ��h� {�ahlar I�IS �n� Ev� Rk'?cl -� 52 -9383 <br /> ' Owner Ma�ling Address City ZiP <br /> n � /� 1 P(� R 12$2 (V1nrvSvi 11 - 98270 Lo53- 2�y� <br /> �� � Cdy Zip Phone <br /> Applicant Mailing Address <br /> � Describe Proposed Work l�.,�-�!, �� ��L�S � ��L��Q P <br /> f <br /> W <br /> � Pra�ect Address(il known) � � <br /> 1 <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> 5 • Property Lines • Centerline of street <br /> � • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and proPosed ulilities • Show measurements M <br /> W <br /> t DO NOT WRITE BELOW THIS LINE O <br /> . PERMITCONDITIONS � <br /> t.All calls for inspection shell be made 24 hrs.in advance•phone 259-8810. <br /> � 2.All work shail be performed in accordance with ihis permit and current City of Everett Design and Consiruction <br /> � Standards end Specilications. � <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> � O, �1 /J <br /> i _ �a.i:?.�.....]L ��0� iC.P:!-c�.u-U-d i <br /> P,/�� �� o <br /> r / H <br /> (.� �c�r�/�-r.nq �ti.w7 ,(.o /k�tccu�� u,J�a,t�i, o-���`'� <br /> s � �' � <br /> G <br /> $'�e,-Sec�Y•v !/�� a f�rikn�� � `1,�e.ef .�if.�' PF'�on�bc,� T e. c�v <br /> A/�, /�p�c✓J-F6'� b�lu�i�'n�• -.(l� O <br /> �/� ,_, tT, a <br /> ����� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �'� The undersi9ned owner/applicant hereby agrees 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-of•way use hereto <br /> applied for and turther agrees to remove same upon notice from the <br /> qpproved lor Construction �a�e City and to replace public property damaged thereby. <br /> � Date /b � �f— <br /> FIN�.L �NSPEC710N ig ure�plicant DAte <br /> Approved as Constructed <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE UILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 9B20t CANCELLED BY 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8670 PROJECT OVER 90 DAYS DURATION. <br />