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_ j / � Publrc 1VorMs Permil. J ����-- <br /> Date '"' �� ppp���,,, ��/ <br /> —�-�-�-'�- oin9 oea�.. �p�/Z���1___ <br /> App�ication For �� _ <br /> PUBLIC WORKS PERMIT Pu�To�Fee��� _- <br /> Less nno��Fa.e Pnw � 0 <br /> eaiance ouc S ��— <br /> Print or Type Only <br /> �e.l,. a /�� /s o 1�l�Z.1 1 S s�l'A-✓t_ �F S o ��.t�. Q�d9C� .�.3�./-6�3' <br /> ' Mading Adtlress Cily Zip Phone <br /> Owner <br /> qpplicant Mailing Address Clty Lp Phone <br /> Describe Proposed Work � N ��i,.,,�?`S�r='-- '�'� <br /> W <br /> Proiect Address lif known) � <br /> Attach four(4) coPies of Plans for proposr.d work- Draw to scale and note the following as a�Plicable: � <br /> • Property Lines • Cen�erline ol strect � <br /> • Ou�line and dimensions of all existing antl • Indicate Norlh <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <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•881 O. <br /> 2.All work shell be peAormed In accordance with this permil and current City of Everett Design and Construction <br /> Standards end Specifications. � � <br /> 3.Ca�l Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. <br /> J� 6�,,�,.� s.��_��, ,F� ��� �2`-� O <br /> �� � .,����:e�-� �- ��'�y �'�-^,.� <br /> ���� . N <br /> O <br /> �`1. �����' G' <br /> s���` <br /> �/� ��a� ACKNOWLEDGEMENT OF CONDITIONS <br /> / �S�/ The undersigned uwner/applicant herehy agrees to hold and save harm• <br /> � / less the City ol Everett from any and all claims for damages, costs, <br /> ��� expenses, or causes of action lhat may arise because of installation <br /> and maintenance ol the improvement or olher right-of•way use hereto <br /> applied lor and lurther agrees lo remove 5ame Upon notice frOm ihe <br /> Approved�or Construc on �a�e City and to replace public properry damaged thereby. <br /> FINAL INSPECTION ��1e Dale <br /> Approved as Constructed Signature ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet6 WA 99201 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone;259�BE510 PROJECT OVER 90 DAYS DURATION. <br />