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_ _ _ �.: <br /> J <br /> Date�� 1_1_�� P„o�,�wo,..Pe.m��,..^—/��-�8''9') -_ <br /> / � einc Deo� � �./—�d—'-5-`Y—�— _ <br /> Application For � <br /> PUBLIC WORK� PERMIT �°°°""°""`a — <br /> Totni Fee S— <br /> le5!ApDI Poe PaiO � O <br /> EalanceDun S �O� <br /> Print or Type Only <br /> 6 �/–/nl ��' <br /> � _.,� i r��,�,,���M �b z��rs-a�l `�s1- dr ii..� tio,Kw� 4�aas <br /> �W�ef MadingAddress CAy Zlp Phone <br /> SQ �� PhOne <br /> qppllwnt Mailing Addiess City 2ip <br /> �,.;,ribe Proposed Work L O a NQ[•l) S I/1��e '1(1lYJ���� � �-'e <br /> -- � W <br /> ProR.:t Address li! kncwn) BDOB — �IE�P /0/AN '4 VE � <br /> ;.Cech four(4)copies ol plans lor proposed work- Draw to scale and nole ihe lollowmg as apP��cable: � <br /> • Property Lines • Genterline oi s�reet � <br /> • Outline and dimensions ot all exis6og and • Indicate Norih <br /> proDosetl structures on ihe lot • Shcw any proposed grading changes <br /> • Exicting and proposed utilities • Show measurements M <br /> W <br /> �—p DO NOT WRITE BELOW THIS LIM1E <br /> PERMIT CONDIT'7NS O <br /> 1.All calls for insnection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall b=pedormed in accordance wilh thic permit and current City ot Eveiett Design and Construction <br /> St:.ndards end Specificxtions. <br /> 3.Cell Localion Underground Service 48 hrs.befere yu�dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACY.NOWLEDGEMENT OF CONDITIONS <br /> /� The undersigned owner/applicant hereby agroes to hold and save ha�m� <br /> less ihc City ol Everett Irom any and all claims for damages, costs. <br /> / , eapenses, or causes ot action ihat may arise because ol installation <br /> �-.,[/� /�� � �/�/8 p and maintenance ol Ihe improvement or o�her right-obway use hereto <br /> �JC'1� z /� �— appfied tor and Iwth�.r ngrees to remove same upon notice Irom Ihe <br /> Approve�or Cons(GCtion �a1e C�ty and to replace p�..ohc or erty damaged th eby. <br /> // / <br /> ���li'�� �"U - �.�1� �.� � <br /> FINAL INSFECTIOW a1z ���- — <br /> Apprnved as Constructed Sigratur o Applicant Date <br /> WORK AUTIIORIZEO BY TH PERMIT MUST BE STARTED WITHIN <br /> everplt PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PENMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlreel gE DILIGENTLY PURSUED TO COMPLETI0�1 THIE PERMIT MAV 8E <br /> � Fveren.WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WCRK ON THIS <br /> Phonc:259�8810 PROJ[CT OVER 90 DAVS DURATION. <br />