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Date�� I�� Pu01ic WoiMs Permit�.--' / 1�� �V <br /> Application For emA.oea�.� �r� �—�� 1-t,1G�-- <br /> PUEiLIC WO�KS PERMIT P°b1fVVO1AbFeC <br /> TolalFea $ <br /> Less noo�Fea Pm� g- <br /> Balenca Dua � <br /> Prin2 or Type Only <br /> C�C�?G F. ll'�'�l `� ' �_��1� E' �' � � �� � �3��`�i'Il�, <br /> Owner Mailing Addres ty ZiP Phone <br /> —�C�'6� <br /> Applicant Mailing Atldress City Zip Ph^ne <br /> Describe Proposed Work � �� I, ��/u � � ���e ��/�"/�� -- <br /> W <br /> a � �'� F- <br /> Pmject Address(if known) � <br /> Attach four(4)copies ol plans for proposed work- Draw�o scale and note ihe lollowing as applicable: � <br /> • Property Linas . • Centedine ol street � <br /> • Oulline and dimensions ol all exis�ing and • Indicate Norih <br /> proposed strucWres on ihe lot • 3how any proposed grading changes <br /> i Existing and proposed utili�ies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for insuection shal;be made 24 hrs. in advance-phone 259-881 5. � <br /> 2. All work shall be periormed in accordance with ihis permit and current���y^!E:�^��tt pesign and Cons�ruction <br /> Standards antl Specilications. <br /> 3. Call Location Underground Service 48 hrs. befe:e you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �UBGfe Wof.rs /����m�T ,dor'��e,��,e�,v <br /> /y7�-,i',,� O <br /> �/G�� � <br /> , � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tha undersiyned owner/applicant hereby agrees'o,iold and save harm- <br /> '— less the City ol Everett trom any and all caim. for damages, cost:�. <br /> expen��es, or causes of aclion thal may arite b�cause o! installa�ion <br /> and maintenance of the imUrovemeN or olher r3hbol-way use hereto <br /> applied for and luriher agrees to remove sei,ie upon notice from lhe <br /> Approved for Consiruction Date Ciry and lo replace pu6lic properry damaged thnreby. <br /> FINAL INSPECTION Date <br /> Approved as Co�siructed Signa;ure of Applicant Date <br /> evere�l PUBLIC WCRKS DEPARTMENT WORK AUTHORIZED BY THIS PERMI7 MUST BE STARTED WITHIN <br /> 180 DAYS O� DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 32^C Cedar Stree� BE DILIGENTLY PVRSUED TO COIdPLETION.THIS PERMIT h1AY BE <br /> cverett,WA 98207 CAhCELLED BY THE CITY UPON ANY ST7PPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVEIP 90 DAYS DURATION. <br />