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Da�e.i�C--��.�� �,�i.i��vn,��,r�.,�„��iy. �-7={�y} <br /> APplicalion for uinu ovw.• �_I_�� 1 I'ID--.— <br /> 1 <br /> PUBLIC WORKS PERMIT ''°^;o,„�oaF"° 5_ <br /> Less AnN feu Vmtl S <br /> PriM or Type Only o������o�� s <br /> -ri�r�h �I����(� .�-�is �i�c ��al ��� ���r= �,����_Fir �2�� a�.�- nc� <br /> Owner � Mailing AdAress City 2ip Phone <br /> ��n�C — <br /> Applicanl Mailin9 Adtli�ss Cily Zip Phone <br /> Describe Proposed Work � L��� ��' �' '� ' � �1��1 <br /> W <br /> Project Addrnss(�1 known) ' �'� - �r � <br /> ABach lour�4� copies ol plans�or proposed work• Draw to scale and note the following as applicable: � <br /> • Property Linr.s • Cente�line of street � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed struclures on ihe lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRIT[ BELOW THIS LINE O <br /> P[RMIT COND�TIONS <br /> t. All calls Ior inspedion snall ee made 2a hrs. in advance-phone 259•881 5. � <br /> 2. All work shall Ue perlormed in accordance with this permit and current Ciry ol Everett Des�9n and Construction <br /> Standards and Specifications. <br /> 3. Call Localion Undeiground Service 4R hrs. before you di9.TOIL FREE NUMBER 1-800•424•5555. � <br /> �.���/� O <br /> �'ijCiC �<'C/.'%S f�C,a_in�T /_���T . 'r�'� i,l'.'-`�� �"1/��9i' <br /> �w <br /> _/ <br /> O <br /> a <br /> ACKNOWLEDGEM[NT O( GONDITIONS <br /> The undersic�ned ownei/apphcant hereby ayrees to hold and save harm- <br /> --- Iess the City of Everett from any and a�l claims lor damages, cnsis, <br /> e.prnses, or causes ol action that may arise �iecause ol installation <br /> antl maintenance ol ihe iinprovement or other righ4nf-way use hereto <br /> . apnlird lor and Iurlher agrees to remove same upon notice irom ihe <br /> Approved lor Construction ����� City nnd to rcUlace public property damaged thereby. <br /> FIN�L INSPECTION ����<' <br /> Approved as Construcicd Sipnature ol Apnlicant ���e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIM1 <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PEFMIT MAY BE <br /> Everelt,WA 98207 CANCELLED 8Y TH[CI7Y UPON ANY STOPPAG[OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />