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Date�'L10 : P�o���wo,w,P�� ��— ,�Jy <br /> 61n0 DeD� � ����—�--- <br /> Application For <br /> PUBL�C WORKS PERMIT PUbTolaFeeFca $_ - <br /> Less AppL Fee Pai� � <br /> Baiance oun S 2� <br /> Print or Type Orily <br /> 1�� L������� ► ��� I ��r�'n�i �i �2nv��,�h . <br /> Owner Mailing Address City 2ip Phone <br /> q B�C�-S7��' RI�2 <br /> Applicant Pdailing Atldrnss Cily Zip Phone <br /> Describe Proposed Work � ^ K �� i`—�—� <br /> � / / n W <br /> Frolect Address(il knownl (.�� � `-�/ ����(�Y �L L�=—�fs--� � <br /> Attach four(4) coGies o! plans for proposed�.ork� Draw to scale and note�he lollowing as applicaMe: � <br /> • Pro7erry Lines • Centerline of street � � <br /> • Ou�'me and dimensions of all existing and • Indicate Norih <br /> proposed structures on�he lol • Show any proposed graAing changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall 6e made'14 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this per,nil and current City of Everett Design and Construction <br /> Standerds and Speci�ications. <br /> 3.Call Location Underground Service 48 hrs.6efore you diy.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEPdENT OF CONDIT.ONS <br /> The undersigned owner/applicant hereby agraes�o hold and save narm� <br /> less the Ciry ol Everelt Irom any and all ciaims lor damages, costs. <br /> e e expenses. or causes ol action Ihat may arise because of installation <br /> O � � (� � � j�g� and maintenance of ihe improvement or other right-o4way use hereto <br /> � 1 applied lor and urt rees �o remove same upon notice Irom ihe <br /> Approve ovConstruction a�e Ciry and,to Je lace pubGc perty damaged thereby. <br /> ;' \ <br /> / �./ <br /> i <br /> FINAL IN�CTt N� � � Yl 31�i f' �'` j% ` '�' �- �`Z!� � — �C -^ / <br /> Approved as Constructed � naWre ol Applicar�� Dale <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSUEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street g� DILIGENTLY PURSUED l0 COMPLETION.THIS PERMIT MAY BE <br /> Everr,tt,WA9A201 CANCF.LL[D BY THE CITY UPOtI ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJFCT OVER 90 DAYS DURATION. <br />