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I • ��7'']� 7 /7cJ <br /> �8te��/� Puollc wo�ks Permit+ " <br /> BIep.OepL• <br /> Application For <br /> PUBLIC WORKS PERMIT P°°Ta,e FBeFee s <br /> Leae ApO�Fee PaIC S—�� <br /> Belenca Due S �� O <br /> Print or Type Only <br /> "1�^vtv.l� �� r1�.1�5r�tY��� iC09 O4k.�� a ,�,2E'rt 4s�v� a-����� <br /> Owner Mai ing Address City Zip Phone <br /> ��� ��,,. � � �„ �1�� �rr�� I Fsl � i� Sl�l (����11�1C� �a37 -7"7R-l!/G, <br /> Applicant Meiling Address Ci Zip Phone <br /> � <br /> Describe Proposed Work �.�,�..bJ—�, '�� <br /> W ; <br /> Pro�ect Address(it known) � I <br /> Attach four(4)copies of plans tor proposed work•Oraw to scale and note lhe following es epplicable: � I <br /> • Property Lines . • Centerline of street � i <br /> • Outline and dlmensions of all axisting and � Indicete North <br /> proposed structures on the lol • Show eny proDosed yradinp chanBea <br /> • Exlsting end proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. AII cells for inspection shall be mede 24 hrs in advance- phone 259•8815. � <br /> 2. All work shall be periormed in accordance with this permit end current City oi Everett Design and Construction <br /> Standarda and SpecHicetions <br /> 3. Call Location Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•BOG424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and seve herm- <br /> less the City of Everett trom any and all claims tor dameges, costs, <br /> expenses, or causes of action thet may arise because of instellation <br /> �� �� s/z�7 and meintenence of the i provement or other right•of•wey use hereto <br /> applied for end further ag es to remove same upon nolice from the <br /> Approved for Constru tion a�e City and place public p operty da aged lhereby. <br /> ./� �..11��i/ 3��zc j — —8 <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT 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 DIL�GENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STUPPAGE OF WORK ON THIS <br /> Phone: 259�8875 PROJECTOVER 90 DAYS DURATION. <br />