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, <br /> . <br /> , � g , 30 <br /> Public WOAs 7ermil• <br /> Date�� eiao oau+.• <br /> Application For <br /> PUBLIC WORKS PERMIT '"°"`"'°""`° • �s°. 3'— <br /> Total Fee <br /> Lees Appt Poc Peia S�� <br /> B��ence Due : <br /> y�o.3/ <br /> Print or Type Only <br /> n �� ' 'il'i0 ('RU��C.. �t1Q. e('.�� Ll.)���Z� ��'7213 <br /> Cf.DUiDQr'1(a FK,�4)ity-ti� Z� Phone <br /> Owner Ma�img Address ��tY P <br /> ��me RS I�('v,�+� Gn-4t• .s- LY�<r•, t ' WR�.� �4�+M1z ;���.c.kc�cc= [.nc iti�'ePs(1C� <br /> Cily Zip Phone <br /> Applicant MaJmg Address <br /> A�E�� `(�\�1L7 ANU •f._ ._. nn w �nn V '�nf_ (1,'i" — <br /> ��m 1 in--��r�-i � <br /> Dencribe Propoeed Work <br /> Rl l.e... R�-l-. «� (�Ac.i F�'c /�uY� �p �32�iD ST�ze,� — <br /> — ' � o �� > � rs <br /> `� � W , <br /> � <br /> , 'LN° �:.. A SS � e � <br /> Project AdAress(it known) _ <br /> Attach tour(4�copie6 01 plane for proposed work•Draw to scale and note the following as applicable: � <br /> � Property Lines • Centerline of street <br /> • Indicate NoAh <br /> • Outline and dimensions ol all existin8 and � Show any proposed grading chanqes <br /> proposed siructures on the lot � $how meesurements M <br /> • Eaisting end proposed utilities W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1, All cells for inspection shall be maAe 24 hrs. in advance• phone ZS9•88�S. I <br /> 2. All work shell be peAormed in accordance with this permit and curreM City of Everett Design and Construction I <br /> StenCerds and Specilicationa. � <br /> 3. Cell Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1•800'424•5555. <br /> l/./ /�'c1�' i97F�/�T'�� �-� !J/hiz '�/�G�' O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned cwner/apPlicant hereby agrees to hotd and seve harm- <br /> ' less the CitY of [verett irom any and all clelms ior damages, costs, <br /> expenses, or causes ol action that may arise because of installation <br /> � � �� and maintenance ot Ihe improvement or other righbof•way use hereto i <br /> 2pplied for and turther agrees to remove same upon notice from the <br /> Approv (or Construc n ; / a�e Ciry and to Place public pro rty damaged thereby. <br /> -'�� ,��lC/ 7;.z T d'� � 4�1� <br /> � Oate Date <br /> FINAt�SPECTION ig ature ol Applica <br /> Approved as Constructed ViORK AUTHORI2 BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WOAKS DEPARTMENT 180 DAYS OF D E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Stree� BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Everetl.WA 98201 CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />