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I 7 a7 Pu�Lc Wods Permil a <br /> Date�SD <br /> Applicalion For BitlA Dept• <br /> PUBLIC WORKS PERMIT PubToaFaeFee s _ <br /> Le55 Fppl.�ae Pd�J S <br /> Balance Oue S <br /> Print or Type Only <br /> ..%aAn �.'�dG �s r 3 i� oAKts ,�-�.EQ,crT �� I asa-� /8 y <br /> Owner Mai4ing Address Cdy Lp Phone <br /> cTo/�iU D i Al�.rf.YlS 13/!v 6Af�E5 �✓+.��� c8� l .��-7.�8 `� <br /> Applicant M�iling Address City ZiP Phone <br /> Describe Proposed Work � �T DG�ST�2 T� �.� /Lf}L/f�S �i✓ ST.e��T i/�� <br /> F2o,�rar= /��us� �a2 � ro s �,91�5 I <br /> W <br /> Prolect Address lil known) 1�(�'O arD S �VERLTT � I <br /> I <br /> Attech four(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � � <br /> • Property Lines � Centerline of s!reet � <br /> • Outiine and dimensions of all existing and • Indicate North I <br /> proposed structures on the lot • Show any proposed grading cha�ges <br /> • Existing and proposed utilities • SYow m=asurements � �� <br /> i <br /> DO NOT WRITE BELOW THIS LINE � O I <br /> PERMIT CONDITIONS <br /> t.All calls for inspection shell ba made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shell be peAormed in accordance N�ith this permit and current City of Everetl Design and Construction <br /> Sta�derda end Specitications <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> ` ' O <br /> � <br /> � <br /> O <br /> a � <br /> i <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett irom any and all claims lor damages, costa <br /> �� �� � expenses, or causes ol action that may arise because of installation <br /> �, � 2-�� and maintenance ol the improvement or other right•of-way use hereto <br /> appiied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date � y/`�7/�D <br /> Approved as Conslructed Sig ature of Applicant Date <br /> WORK AUTHCIRI2ED BY THIS PERMIT MUST BE STARTFD WITHIN <br /> everet[ PUBLIC WORKS DEPARTMENT 180 DAYS OI' DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CederStreet BE DIIIGENTLY PURSUED TO COMPLETION.7HIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITI'UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�88t0 pROJECT OVER 90 DA"S DURA710N. <br />