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i <br /> , <br /> Uate�� Pu�bc\Poiks Perm�t• <br /> lication For eina�oeoi.+ <br /> App' <br /> PUBLIC WORKS PERMIT Pu�TotaFceFae s -- <br /> Le:s AOPI.Fec Peia � <br /> BTIdpCC�UC S <br /> Print or Type Only <br /> � Y � � 7 I�JLJ��/ � / I 1 � �.'�^1 L�^ �� `/L}�l� ILLJI/� 355r(A/-�.J <br /> p,�, Mailmg Address City 2iP Phone <br /> x qPP�iCan`� Mailing Address City Zip Phone <br /> Describe Proposed Work (��— ' <br /> Proiect Atldress(if known) ��I ' , I�f� � � I <br /> Atlach lour(4) copies ol pl�ins tor proposed work- Draw to scale anC note Ihe following as applicable: � � <br /> • Prop=rty Lines • Centerline ol street � I <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed stnictures on lhe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS <br /> t.All calls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shidl be peAormed in accordonce with this permit ar,d current Ciry ol Everetl Design and Construction <br /> Standards and Speci(icalions. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> iji-, 6'B <br /> ��y ��,��u�r�l'��r�� � O <br /> � <br /> � <br /> O <br /> a <br /> �CKNOWLEDGEMENT UF CONDITIONS <br /> The undersigned owner/applicant hereUy agrees to hold and save harm� <br /> — less the Ciry ot Everett Irom any and all claims lor damages, cos�s. <br /> eapenses, or causas of action ihat may arise Uecause of installation <br /> and maintenance ol the improvemenl or other righl-of•way use hereto <br /> applied lor and lurther ayrees to remove same upon noticc Irom the <br /> Approved for Construction Date Ciry and to replace public property damaged ihereby. <br /> FINAL WSPECTION Date <br /> Approved as Consiructed Signalure of Applicant Date <br /> WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere[t PUBLICWORKSDEPARTMENT �g0 DAVS OF DATE PERMIT IS ISSUED AtJD lHEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY EE <br /> Everett,W�98201 CANC[LIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone.259�8010 PROJECT OVER 90 DAYS DURATION. <br />