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� �� -� �� <br /> PUUIic 1Vorke Poem�il• <br /> Date� �� eiac oao� + <br /> Appliwtiun For <br /> PUBLIC WORKS PERMIT ""°"``"°",`°° s �'�,C ° _ <br /> Taai Fae <br /> �eas noc�Fea Pem S__.---- <br /> Baience�ue S ��' ���� <br /> Print or Type Only ���✓"y <br /> �c,y,vr.,,) ,�i9< Ty /��.5 �i�'��v Fi'�' ��1- � <br /> r� i Phone <br /> Owner Mailirtg naore» • <br /> � S�C^ phone <br /> Applicant Mailing Address ���y Z�P <br /> c�vsr�P��r s�r�v��_' �r��.�y f��f'� — <br /> Destribe Proposed Work � <br /> � <br /> Pro�ect Address(if known) <br /> /��0� _ �Q t� /�� �$'- L • v� H <br /> � <br /> Attech four(4)copies ol pluns for proposed work•Draw to scale and note the followi�g as applicable: � <br /> • Proparty Lines • Centerline ot slreet <br /> • Indicate North <br /> • Out�lne end dimensions ol all existing and � Show any proposed grading changes <br /> proposed slructures on the lot � Show measurements M <br /> • Existing and proposed utilities W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1, All celis for irspeclion shall be made 24 hrs. in advance- phone 259•88�5. <br /> 2. AII woi�c shall be pedormed in accordance wilh ihis permit and wrrent City ol Everett Desifln and Consiruction <br /> Stenderds and Speciticatlons. � <br /> 3. Cell Location Underground Service 48 hrs.betcre you dig.TDLL FREE NUMBER 1-800•424•5555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF I:ONDITI(]NS <br /> The undersigned owner/epplicant hereby agrees to hold and save harm• <br /> less the City of Everelt irom any and all claims ior demages, costs, <br /> ezpenses, or causes ot action that may arise because o� installation <br /> //a`!�� and maintenance of �he improvement or other riqhPof-way uce hereto <br /> � applied for and luriher agrees to remove same upon notice irom ihe <br /> Ap¢toved for C st ion a1e City and lo replace public property damaged thereby. : <br /> � � ` r-l c /-. / �"'�� ��. Y ti ��� <br /> FINAL INS ION Date � � � Date � <br /> Approved as Constructed Signature ot Applicant <br /> WORK AUTHORIZ[D BY THIS PERMIT MUST BE ST.4RTED N'iTHIN <br /> everett PUBLIC WORKS D NT 180 DAYS OF DATE PERMIT IS ISSIIED AND TFIEREAFTER IS TO <br /> � 3200 Cedar Stree� BE DILIGF.NTLY PURSUED TO COMPLETION.ThIIS PERMIT MAY BE <br /> Evete��,WA 98201 CANCELLED BY THE CITY UPC V ANY STOPPAGE OF WORK ON THIS <br /> � Phone:259�8815 PROJECT OVER 90 DAYS DURNiION. <br />