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Date �� � � L <br /> PuoL<works Permn• � <br /> Application For eioq.oeo� � .. <br /> PUBLIC WORKS PERMIT PVbTo�Fee�Ge s <br /> Last A{�o<<ee Peie S <br /> Print or Type Only � ee�a��ec�e s o7c7=� <br /> ' A/Ai►'0 /C' �.r'/Pft f3/9 /�LSE �l'E' f"I�E�Gi1 ��9� �/�'•"vn3 3s�3- �J,�3:3 <br /> Owner Mailing AdAress Cit� Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Pronosed Work IQLA['%! l��P CN /� SP./t�E' �F �/ �}C 1Z lN F�cy�— df <br /> }�v �}�vlE <br /> W <br /> Project Address�if known) � <br /> Attach lour(4)copies ot plane for proposed work•Draw to scz'e and note the following as applicable: � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions of all exisiiny anu • Intlicate Nonh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show mr.asurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIJNS <br /> 1. All calls tor inspection shall be made 24 hrs. in advance-phone 2S9•8815. � <br /> 2. All work&hall be perlormed in accordance with ihis pe�mit and Current City ot Everett Design and Consiruction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you diq.TOLL FREE NUMBER 1-800-424•5555. � <br /> /� cUI�'/�/n�i9cm� �5�-��'iG c� .�c�c�%2�_� ��i«c�.� O <br /> S�'<<�- G��._= � i='�,E'b�<_.� �,��=� <br /> � <br /> � <br /> � <br /> �y� ����a� � <br /> �C�J/ .,, ., ..rrr , _ c�, ,�a , <br /> ACI�NOWLEDG@MEN7.QFCONDITIONS � <br /> Tha undersigned owner/appli�aqt h¢feby aqrgy�;fo hold and save harm- � <br /> less the C�ly ol Everett irorR���nyi;and 2il.c�eims for damages, costs, <br /> �' ' expenses. or causes Of action tfi�at may an`se�because of installation <br /> !/ / / /� and maintenance ol ihe improvr,ment or ether right-ot�way use hereto � <br /> �� applied �or and luriher agrees �o remove same upon no�ice from ihe <br /> Appr etl for Consf(uctio � . Da e City and to replace pubhc property damaged thereby. <br /> � �/�/ ,/L % �/L' -C % � /� <br /> FINAL`INSPECTION D�je ��-!�^�i �O���G � ��n/�� <br /> qppreve0 as Constructed Signature of Applicant TD�dt�e— <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOPIZED 8 THIS PERMIT MUST BE STARTED WITFiIN <br /> � 180 DAYS OF DATE PEflM1T� IS ISSUED AND TfiEREAFTER IS TO <br /> 3200 Cedar Streel BE DILIGENTLY PUR$UED TO COMPLEfION. THID PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED �V iHF GITY UPON ANY 5 iDPPAGE OF WORK ON THIS <br /> Phone: 259-9815 PROJECT OVER 90 DAYS DURATION. <br />