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! <br /> Dat��'�S—� TO POSTING_ ��/-q`I Pum�cWaasvermn. � � � <br /> Application For eieo oeo�.• <br /> PUBLIG WORKS PERMIT PuObCWOtk6FlB <br /> ,o�e���a s <br /> Ll56 PDP��F!!PeiE S <br /> �� <br /> Print or Type Only Balance Due S �o <br /> �i?0. 30 X I�l l�l <br /> �, 1 � S . '7G�2� UP�r�+2 Y��c-tG �, Ev���c. wa. �Szo(� <br /> Owner Mai4ing Atldress Cily 2ip Phone <br /> _ �J V�� ✓/a-�J U Z�i-G , Z�ir'1 �'��08 <br /> Applicant MailingAddiess City Zip Phone <br /> DescribeProposedWork y^��t"���N 0� 3�K�-�'I��I�'— �.�L.t�L1� <br /> . Project Address(if known) �ll�( 7 ���) � O�i � <br /> � <br /> Atlach four(4)copies of plans lor proposed work� Draw to scale antl note the lollowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Ou�line and dimensions of all existing and • Indicate North <br /> proposed structures on ihe lol • Show any proposetl grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cvils for inspection shall be made 24 hrs.in advance-phone 259•8870. � <br /> 2.All work shall be peNormed in accordence with thi,pormit and current City of Everett Design and Consiruction <br /> Standards end Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUM82R 1•B00•424•5555. � <br /> /� F�oS�oN Co/JT2oc 5 A�,o�C� SOu�'�� A�t10 Ed5 1 P�'��`( O <br /> L/�)Es (,U H C—�� lol'E6E55�1.�, <br /> 5. Co�us��2u c� Pe-/: �p�,�ovc�v �.�.ce� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEtviENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City ot Eve�ett Irom any and all claims lor dameges. cosls, <br /> �� ezpenses, or causes of aclion that may arise because ot installation <br /> �d `S and maintenance ol ihe impwvemen[ or other right-ohway use hereto <br /> Appro d lor nstructio � ate applied for and further agrees to remove sam= upon notice Irom the <br /> City and to replace public property damaged thereby. <br /> '. .__ �� d/ , �t <br /> � 1 C <br /> FINALINSPECTION � � bate �"'--�'��� ID�("1 •� � <br /> Approved as Constructed Signature 1 Applic nt D2te <br /> �Ar� PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLFD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS �URATION. <br />