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� <br /> I `�i �+`"' I <br /> Date S -� � PublicWo�kePatmll� � <br /> Applica�ion For eiaQ oen�.• %���� 6 /�'7 2 <br /> PUBLIC WORKS PERMlT Pul�ticYlo�kaFee - <br /> Totnl Feo $ <br /> '_ess Aool Fea Paid $ <br /> ❑alanca Duo � I <br /> Print or Type Only <br /> ,�J ,e... !/CiZCi z2�ee �� i/,o c�.-�-fF--t�-,r� - � <br /> wner Mailing Address City Zip Phone <br /> .7 �..a - ��e� ` — <br /> � <br /> Applicant _�— Mailing Address City Zip Phone <br /> DescribeProposedWork � �cc5 "" �•'`' �� <br /> W <br /> Prolect Address(i! known) ��U� � 'F� c�y' — � <br /> Attach lour(n)copies ol plans for proposed work- Draw lo scale and nole Ihe lollowing as applicable: os <br /> ! Propeity Llnes � Cenleiiine ol streel /� <br /> • Outline and dimensions ol all exisling and • Indicate North �� <br /> proposed slructures on Ihe tot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements /�/� <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 2A hrs.in advance•phone 2�59-8810. � <br /> 2.All work shall be performed in accordance wilh�hls permit and current Ciry of Everett Design a�id Construction <br /> Standard�and Specitications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•42�4•5555. a� <br /> L <br /> ��c�lit'_•"�. �u��a_�'<. ��c�,,... � (� /�'��r /'�c�� � <br /> �� ��� /J-�c.z.1>r <br /> S . � � _ n � �w <br /> �V <br /> � <br /> � <br /> ACKNOWLEDGHMFNT OF COMDI1lONu <br /> The�mdersiyned ownr.r/applicant hcrr.by agrees lo hold and save harm- <br /> ------- — Iess the Cily of Evorelt Irom any and all claims lor damages, costs. <br /> expenses, or causes of aclion Ihat may arise because :I Instellotion <br /> and maintenance ot ihe improvemenl or other righ4ol-way use hereto <br /> applied lor and lurlher agrecs to remove same upon notice Irom Ihr. <br /> �pproved lor Conslruc�ion �a�e Ciry and lo replace public p�oper�y damnged thereoy. <br /> FINAL INSPECTION Date - ----- <br /> Approved as Consir�cted Signatw�: ol App:icanl Date <br /> '; PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PGR�41T MUST BE STARTED WITHIN <br /> � 180 DAVS OF DATE PERMIT IS ISSUED AND THEf�EAFTER IS TO <br /> 3200 Cedar Slreel BE DILIGENTLY PURSUE�TO COMPLETION. THIS PERMIT MAV 6E <br /> Fverr.tt,WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> Phone:259�8810 PRO.IECT OVER 90 D�YS DUfiATION. <br />