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� <br /> I C <br /> .. . � � ... � . . � . .. � I�� � , <br /> � � <br /> _ e��'� <br /> �m � <br /> -I�/� P,�ItM1c\Po.Yf P� <br /> DetE'Sj�L11—'J 1 � uin�o�.o� . �� - <br /> Appliwlion For ___ <br /> PUBLIC WORKS PERMIT ``,-,°''°"'°"°"° <br /> r��.,�«� 5- <br /> �css nnoi �ne va�a S <br /> pa'anceDue �+ r <br /> ���� Print or Type Only <br /> ��" � 3� ��`ir`�" [o°�� � .E�X o�2�'1 LQ.'A� 1 �1 GI�C� <br /> 9 H V� . Zh Ph�ne <br /> C x>.,, wner Mailing Atldress ��Y �J <br /> y zH <br /> FC C'� <br /> H� Zip Phone <br /> � 'r�'j�y. Applicant Mailing Address City <br /> V1 H '^� In <br /> xzg <br /> �Y K 4I l � �— <br /> C�] p[� Descrbe Propc.ed Worh _ <br /> H C7 <br /> O H <br /> ��g � <br /> � ` , ' �.. <br /> r H y Pro�ect Address lif known) <br /> � y H A tla ch low�4)coF�es ol plans lor pmposed work- D�avi to sca antl note the followi as applicable� � <br /> dq� • Property Lines • Centeriine ol street � <br /> � [r1 C O Outline and dimensions of all eaisling and • Indicate Nor�h <br /> proposetl siructures on'he lot • Show any pwposed grading changes <br /> H �� • Ezistiny and proposed utilities • Show measurements � <br /> � �� DO NOT WRITE BELOW THIS LINE � <br /> PERHIIT CONDITIONS � <br /> t.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pedormed in acwrdance wilh this parmil and current City ot Everett Design and Consiruction <br /> � Standards and Specilications. <br /> '� ,�' 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> a,� <br /> _ _' f�0� ��(� ��i�.= 0 <br /> !- � <br /> 5-,�G-9% � <br /> _� � <br /> ��,—,� ��^k-�� � <br /> „i^: <br /> c, � ACKNOWLEDGEAfENTO�CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to holtl and save harm- <br /> less ihe City of Everetl Irom any anci all claims lor dama9es. co�is. <br /> a `� e:penses, o� causes ol action ihat may a�isu because o� installalion <br /> +!+1� and maintena�ce ol the improvement or other righ��ol-way use hereto <br /> _ applied for and further a9ree5 to remove same upon notice Irom the <br /> Approved br Consiruction Date City and to iePlace public property damaged thereby. <br /> a- , % <br /> FINAL INSF'ECTION Date Date <br /> ApProved as Consiructed Si9nature ot APplicaN <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> Oi.������ PUBLICWORKSDEPARTMENT 1B0 DAYS Of DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERh!IT MAY BE <br /> Everelt.WA 98201 CANCEI.LED 8Y THE CITY UPON F.NY STOPPAGE OF WCRK GN THIS <br /> Phone:259-8870 PROJECT OVER 90 DAYS DURATIJN. <br /> � .i:i<;...:,: . <br />