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Date��1� PuObcWo.wsP �` /73 �/ <br /> AppliCation For 6ine Deo�.•-5���� <br /> PUBLIC WORKS PERMIT PueToalieeF1e s_ - <br /> Less Appl.F!e Pdid .S <br /> CaianceDue S �Q�- <br /> Print or Type Only -- <br /> IL�� �'�YIYY�f'�'�� ]�c]-���—9�SaAl� �3y�.� <br /> Owner Mailing Address City Zip phone <br /> YTI 1 l� _ <br /> Applicant Maiiing Adtliess Gry Lp Phone <br /> Desciibe Proposed Work �1 � <br /> � ProjectAddresslilknown� %�z�f - D�C'C'A (//Ezf.r �� � <br /> � <br /> Attach low(41 copies of plans for proposed work- Draw to scale and note the following as apPlicabie; � , <br /> • Property Lines • Centerline of street � � <br /> • Oulline and dimensions of all existinq and • Indicate Norih <br /> proposed struclures on the lol • Show any proposed grading chanaes <br /> � • Ezisting aod proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O ; <br /> PERMIT CONDITIONS <br /> 1.All calle lor inspection shell be made 24 hrs.in advance-phone 259•8810. � <br /> 2.AII work shell be peAormed in accordance with this permil and current Cily of Everett Design and Construction <br /> Standards and Specilicatlons. <br /> 3.Call Lxation Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800-4245555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENi OFCOt1DITIONS <br /> � J 7he undersigned owner/applicant hereby agrees to hold and sa•.e harm- <br /> less the Cily of EvereO Irom any ana all claims for damages, costs. <br /> expenses, or causes of action that may arise because ol installation <br /> .,.� GL�� „s� � and main�enance ol ihe improvement or other righ�-of�way use hereto <br /> applied for and further agrees to remo�e same upon notice irom ihe <br /> Approved lor Constru ion �a�e City and to r plac ublic property damaged thereby. <br /> �� � r-f� ���-�� <br /> FINAL INSPECTION Date <br /> Approved as Constructed Si n p6c t Date <br /> I THORI2ED BY THIS PEFMIT MUST BE STAIiTED !NITHIN <br /> everelt PUBLICWORKSDEPARTMENT �g [iqyS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200CedarSireet BE DILIGENTi.I' PURSUED TO COM?LETION. THIS PERMIT MAV BE <br /> Everetl,WA 98201 CANCELLE6 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB10 PROJECT OVER 90 DAYS DURATION. <br />