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� <br /> Dal�� Pu�bc Woda Pormll. .��— y8 g <br /> eiae oeai.. <br /> Application For <br /> � PUBLIC WORKS PERMIT �uOTOInIFoaF�� _ <br /> Less PpOI Fee PeiJ $ q <br /> Baiance Ow S d C n�-�-� <br /> Print or Type On�y <br /> �1��, � LVad"! <br /> Owner Mailing Address Ci�y Zip Phone <br /> / a Il�i t�rS�ZGt� <br /> �o�,��s� (c,.� 1la�'s NI� 1`6 lol�t Mer�1 �,�—�1�— <br /> Applicant Mailing Address City Lp Phone <br /> . C ` a ' � <br /> � Describe ?roposed Work r <br /> S_FE c Eo LocArio�c% <br /> W <br /> Prolect Address(il known) �h z L E �1ae�� �3� �ye � <br /> Adach four(4)copies oF plans lor proposed work• Draw to scale and note ihe lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimension5 ot all existing and • Indicate Norih <br /> proposed structures onthelot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8870. � <br /> 2.All work shall be peAormed in accordance wilh this permit and current City oi Everett Design and Construction <br /> � Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�netl owner/applicant hereby agrees to hold and save harm� <br /> less lhe Cily ol Everelt Irom any and all claims lor damages, costs. <br /> 1 expenses, or causes of action that may arise because of installation <br /> �. � // p O and maintenance of ihe improvement or other right�ol-way use hereto <br /> v applied lor and further agrees to remove same upon notice Irom the <br /> Approved lor C lructio Date City and to replace public t�roperty damaged thereby. , <br /> �� t <br /> �� /.�— 3-9v 1�� C <br /> AL INSPECTION Date y���o"" �^ 1�""� n d Nn� 9'v <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAfTER IS TO <br /> � 3200Cedar^2reet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />