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Date� g , a PUGLc Worke Permit� �J �� <br /> BIEq OeO��• <br /> Application For <br /> PUBLIC WORKS PERlMIT PubTotalFeeFee s <br /> Lesi RDO�Fee PniO S. <br /> BaianceDue s. •35�0 <br /> Print or Type Oniy <br /> G{�J2 322-'f0-c�-!/-83/ <br /> ��1�/D-��GF Hasi' �O doX /G'�� �dE,efir cda' 9'9�D� aS8-7t�/� <br /> Owner MaiNng Address City Zip Phone <br /> Appiic&nt Mailing Address City Zip Phone <br /> Describe Proposed Work ���t/ST.Q/i�T 'VEC✓ i'!�/.I C _�/i/LCi.t/lr ly��-3 w� <br /> S�[.tfn4GG /L�Ficl �i�JiO� S�w�� . 2'<<���'e <br /> i1v''�' ��✓O �'.PoJ� iit/.9GE. <br /> -� O W <br /> Projecl ACAress(it known; _L� � �' � <br /> Attech tour(4)copies oi plans for proposeA work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine of street /A <br /> • Outlir.e and Eimensions ol atl existing anA • InAicate North M� <br /> propose0 structures on the iot • Show any proposed grading changes <br /> • Existinp and proposed utili!ies • Show measurements � <br /> DO NOT WRITE BELOW TH�S LINE O <br /> PERMIT CONDITIONS <br /> +.M�caus for�nnpedion sha��be made 24 nrs.in advance•phone 258�681 O. � <br /> 2.All wark shali be peMormed in accordance with this permit end current Ciry of Everett Design and Consiruction <br /> StandarAs�nd Specifications. <br /> 3.Cell Locetion Underground Service 48 hre.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> � �J� vTi�.TiE_' To ,/�' I.t/STiS�G�Ed Pc� O <br /> f��o,i�-o �.9.✓ v��� ia-z s�B8. ��'a y .9�ACH,�o� <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appl�r;ant hereby agrees to hold and save harm� <br /> less the Ciry oi Everet� from any and all claims lor damages, costs. <br /> �� ��� ezpenses, or causes of action that may arise because o1 installalion <br /> G /O /� g and maintenance of the improvement or other right-ot�way use hereto <br /> applied for and further agrees to romove same upon notice Irom the <br /> Approved tor Constr� on a�e Ciry antl to re ar.e publi property damaged theieby. <br /> � .s=/-�f 0—�l,—� <br /> FINAL INSPECTION � Date <br /> Approved ss Consiructed ignature of Applicanl Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PUi3LICWORKSDEPARTMENT 1g0 DAYS OF DAtE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAV E3E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAVS DUAATION. <br />