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Date �" �il 1 a�roi��wo,k�v��yy��i/� '-J_`T��} `_�`� �� <br /> Applicatirn Fo� e�nq 000t.� _-l�L.�.Lx�� . <br /> PUBLIC WORKS PERMIT � �1•��FeeFee $ -- <br /> Less Appi Fee Pam $ <br /> eninnrn ouo S ��'T— <br /> Print or Type Only <br /> ��m v��a �',r}rr�-� �-I 3 I Ir>y�� �'L 5� �V�J"�t"T 9�� <br /> Own Ma�ting Atldress City 2ip Phone <br /> � � 'b7�� <br /> AppGeant Mailing Address Ciy Zip Phone <br /> Describe Proposed Work ��_ _ <br /> ,C� /7� W <br /> Pro�ect Address(il knnwnl 7�2� — `! a*�"��•'"'�1+'. � <br /> Attach four(4)copies ol plans for proposetl work- Draw lo scale and note the following as applicable: � <br /> • Property Lines • Centerline of stree� � <br /> • Outline and dimensions ol all existing antl • Indicate North <br /> proposed siructures on the lui • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIO�S O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•82f1 O. � I <br /> 2.All work shall be p=rformed in accordance with this permit and current City of Everett Design�nd Construction <br /> Standerds antl Speci(ications. <br /> 3.Call Location Underground Serv�ce 48 hrs.before you dig TOLL FREE NUMBER 1•$00-424-5555. � ' <br /> i <br /> O � <br /> � <br /> � ; <br /> O <br /> a <br /> d p �CKNOWLEDGEMENT OF CONDITIONS <br /> /1�^' <br /> � f The undersigned ownei/applicanl hereUy agrees to hold and save harm- <br /> less ihe City ol Everell Irom any and all claims lor damages. cosis. <br /> expenses. or cxuses ol action that may arise because of installation <br /> ' , �: � a � ��r and mainlenance of ihe improvement or other right�ol�way use hereto <br /> • �� � ' applied lor and further agrees to remove same upon notice irom the <br /> Approved or Consln ction f� Dale �•;,��i�� �o replace pubGc property damaged thereby. <br /> l > ��� ,��/%/�� �� -{ � 2 e <br /> FIN L INS ECTION P Date _l�'�-""""�" Gf/ �Jap-r N--�� v_/� /�/ <br /> Approved as Consiruct?d Sic�raturc ol Apphcan� Date <br /> everetl PUBLICWORKSDEPARTMENT WUIiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 OAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br /> Everett.lNA9B201 BE DILIGENTLY PURSUED i0 COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�eB10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />