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n l/ .� �� <br /> Date �vc� ���c�� r�����v,o,k�F�.m�a��. <br /> c? <br /> Application For e�a� ocn�.•.�2 � <br /> PUBLIC WORKS PERIVdIT PubTOIY01FBaFeo S <br /> �ess ApO�Foa Paitl $ <br /> Balance Dua S <br /> ?rint or Type Only <br /> �Y�..�� 55��'� 5 r\/�,���1� � `141�-�'1R7�� <br /> Ownor Mailing Address City Zip Phone <br /> ?��L�►�t���� �l��b3 185� PC,�'� {��.,�i <br /> Ap licant Maihng Address City Zip Phone <br /> Describe Proposed Work _J�d11(�.LV—•!��-��� ���� 7 �I�» �v�'l''� <br /> W <br /> Project Address(it known) ^ � <br /> Attach four(4) copics of plans for proposed work• D�aw�o sCale and note the following s applica6le: � <br /> • PropertY Lines • Centerline ot street ♦^ <br /> Y Outline and dimensions of all existing and • Indicate North �� <br /> proposed structures on the lot • Show any prnposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shau be performed in accordance with this permit and current City of Everell Design and Construclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•4245555. � <br /> Y1�T ��Ui��.0 /��T o <br /> �� H <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hoid and save harm- <br /> less the City ol EvereU from any and all claims for d�mages, costs. <br /> expenses, or ca�ses o( aclion that may arise bec^�se of installation <br /> and maintenance oi the improvement or other rignhohway use hereto <br /> applied for and further agrees to remo�•? same upon notice trom the <br /> :,pn�oved for Construction Data Cily and to replace pubhc properly damaged thereby. <br /> FINAL INSF'Et,fION �a`z <br /> Approved as Constructed SirnaWre of Appliwnl Dace <br /> WGRK AUTHORIZEO BY THIS PERMIT MU.`�iT 8E STARTED `NITHIN <br /> evemtt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT 1S ISSUED AND THEREAFT[R IS TO <br /> � 3200CedarStreet Bc DILIGENTLY PURSUED TO COt.IPLETION.THIS PERMIT M,\Y BG <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:239-8810 PROJECT OVEF 90 DAYS DURATION. <br />