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� . . <br />� <br /> Date Q' �S/V � PUEIic Work�Pe�mll• � � � <br /> Appliwtion For eiaa.oeoi• <br /> PUBLIC WORKS PERMIT P°°;o;;°F:`°° : <br /> Les��oo�Fee v�ia a <br /> B�I�nce Due f �� �/y/��s� <br /> Print or Type Only <br /> 0 . Pw�r � �ot,nson , izbao �4�" avF w �vE �2�Tr 9s'�co�` 3�Fg- o691 <br /> Owner Mailing Address City Zip Phone z <br /> a <br /> 5 AMr � <br /> Applicant Mailing Address City Zip Phone •• <br /> Descrihe Proposed Work 1� E* R Vd F � �D Y�'1 P O 5 l T L O Y� . <br /> P L.A C � D U vr�PSTE 2 _/.1 Ti-IF R D.W. ON 7HE /l/U2T�s' y � <br /> S//�E OF BlJ/GD/N!r FO�C' TN/O D/�y!/S �$'T4 T/A/lr N „y <br /> 5� �-�-9s_ W � E� <br /> Proiect Address(il known) C — U ' � y <br /> O <br /> � Attach four(4)copies of plans for proposed work• Draw to scaie and note lhe following as applicable: � <br /> + • Properly Lines • Centedine of street ' <br /> • Outline and dimensions of ell existing and • Indicate North N Z <br /> proposed structuree on the tot � Show any proposed grading changes � <br /> � • Existing and proposed utilities • Show measurements "�' <br /> H <br /> DO NOT WRITE BELOW THIS LINE � N <br /> PERMIT CONDITIONS O '�*J � <br /> 1. All calls for inspection s}all be made 24 hrs. in ativance- phone 259•881 5. � � <br /> 2. All work shall be periormed in accordance with this permit and current City of Everett Design end Censtrudion H <br /> Standerde end Specificetions. N <br /> 3. Call Locetion Underground Service 4B hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> �C,�tJ►�t Ed CS '�1CP�-�S 3��'�3�1.1�� C�I-1 �p� O � <br /> ��� C�F `i'�� �)F'C�'`3�� . <br /> � � <br /> � � <br /> O N <br /> a � <br /> � � <br /> ACKNOWLEDGEMENT OF CONDITIOIJS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt Irom any and all claims for damages, costs. <br /> xpenses, or causes ol action that may arise because of installation <br /> �'7� !1�f��7 � n nd maintenance of the improvemenl or other right•o4way use hereto <br /> � � / ��� �� 4—���� applied lor and lurther agrees to remove same upon notice Irom the <br /> Approved orConstruc'ion � �a�e City and to replace public roperty demaged thereby. <br /> — , _���_�L���� <br /> �L�NSPECTION � Date • 1"•''"' <br /> Approved as Constructed Signature ol Applicanl Date <br /> everett PUBLIC WORKS DEPAHTME,VT WORK AUTHORIZED BY THIS PE IT MUS7 BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMITISI UED AND THEREAFTER IS TO <br /> � 3200 Cedar Street iiE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259-6815 PROJECT OVER 90 DAYS DURA710N. <br />