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�. --� --._ <br /> Date� / � � PUCIrc WOrkt 7erpmlt• p, <br /> AppliCeti0i. . 9f BiEp.Deot• p��� 7�dS <br /> PUBLIC WORKS PERMIT PuDIKWork�fee - <br /> Tolel Fee s <br /> Leae AOOL Fee PeiE s <br /> Print or Type Only 8.�.�«o�� f <br /> �hP.t ��U�a0�d `�z /�D L x 3�„�/yJ„E:lJ�pi� 98 a75 355-5[j Q4� <br /> Owne� ^MaiNng Address City 2ip Phone <br /> �M � <br /> � AppliceM Mailing AdOress Ci�y 2ip Phone <br /> Describe Proposed Work 7Pnpn�" !n�T r�r�vP.wi artf - ,�.-�,�F/�Rr - ��s,�� 0'1�;'�ar <br /> W <br /> Project Addreas(il known) � <br /> Attach tour(4)copies ot plens for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Out�ine and dimenaions of all existing and • Indicate North <br /> proposeA structures on the lot • Show any proposed grading changes <br /> • EKisting end proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O �, <br /> PERMIT CONDITIONS �� <br /> t. All calle lor inapaction ehell be made 24 hrs. in advance-phone Zb9•88�$. � <br /> � 2. All work ehall be peAormed in eccordance with this permit and wrrent City of Everett Design and Construdion � ��� <br /> Standards and Specilications. <br /> � 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �C.J�LIC L�f,Y'.fs ,aF.c�iriiT /1IoT ,e�+Ui.PEO � Z�S7 O <br /> � � � <br /> � <br /> O <br /> a <br /> ACKNOWLEUGEM[NT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — less the City of Everett irom any and all claims fo� damages, costs, <br /> ezpenses, or causes ol action ihal may arise because ol installation <br /> and maintenance of the improvement or other right-ot�way use hereto <br /> applied for and furiher agrees to remove same upon notice from the <br /> Approved br Cons�ruction Date Cily and to�eplace public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed SignaWre of Applican� Date <br /> everett PLIBLIC WORKS DEPAfiTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS 70 <br /> Everr,it WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />