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��, <br /> � <br /> D8t@ '�/' , /r�G PaEI rR�Perm�t♦ <br /> !If/.d�IX <br /> ['�/'r�V BIOp.DeOL• <br /> / � <br /> Application For <br /> PUBLIC WORKS PERIlAIT PubTo�IFeeF� : <br /> Less AppL Fee PeiE f <br /> B��moe Due s <br /> Print or Type Only <br /> � o...i. p �,..w {tP II�i' I S�S �4 t��—�NA� � Qt� <br /> OW's'�'Y— Mailing Address City Zip Phone <br /> �� ,s, loQk���— I�au� -Sg�i.. A.,v u� �.�u n 9�adN <br /> Applicant Meiling Address City Z P Phone <br /> l�O A�n�e c lA A r fi l i� /�R Mil Dt--�`��.i- .[ n-�..fi+. � �:L�-�—l�dl///� <br /> Dencribe Proposed Work � <br /> W <br /> Pro�ect Address(it known) � <br /> � <br /> Attach four(4)coples of plens for proposed work-Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline of street <br /> •Outline and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exiating and proposed utilities � • Show measurements M <br /> W <br /> I, DO NOT WRITE BEIOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> � 1. All calls for inspection shell be made 24 hra in advance•phone 259•B8�5. � <br /> 2. All work ahell be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> StanderAa and Specificetions � <br /> � 3. Call Locetfon Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-124•5555. <br /> O <br /> �j f�v.6���c G�a,�,F.� f�E",P�»�T 2Eq����F��/a/B� � <br /> � O <br /> a <br /> IICKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby a�rees to hold and save f�2rm- <br /> iess the City o1 Everett irom any and all c!aims for damagea costs, <br /> expenses, or causes of action that may arise because ot installation <br /> and maintenance of the improvemenl or other rlghhof�way use hereto <br /> applied tor and further agrees to remove same opon notice irom the <br /> Approved for Construction Date pi�y and to replace Public property damaged thereby. <br /> FINAL INSPECTION Date � Date <br /> Approved as Constructed Signature of Applicant <br /> PUBLIC WORKS DEPARTMEN� WORK AUTHORIZED BY THIS PERMIT MUST BE uTARTE[: WITFiIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEh IS TO <br /> � 3200 Cedar Street BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT M,\Y BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON �HIS <br /> Phone: 259�8815 pROJEC7 OVER 90 DAYS DURATION. <br />