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Date�E.'S I P��.,<<:o,�,Pe,m.. <br /> emq oeo� • <br /> Applica�ion For <br /> PUBLIr WORKS PERM17 a��ToieFecFee $ <br /> Lesa A00�.Fee Gaid 5_ <br /> Balance Dua g <br /> Print or Type Only <br /> MO�S/iCd /Y/Fs/E,� �96C� - l��=:S.�E.c"�.f' F//E.�E� <br /> Owner � Mailinp Address Ci1y Zip Phone <br /> Applicant �lailing Address Ciiy Zip Phone � <br /> H <br /> CON-sT�PGGT L7e'"C.f' �f� �!SiGh�� iit/ B.aC,C � ,�',� <br /> Describe Proposed Work _ �—� <br /> - W � � <br /> — H "+7 <br /> Pmiect P.ddress(i(known) 0 ' �E'SPEie '�'e. � � �, <br /> Altac'i lour(4)copies of plans lor proposed work- Draw to scale and note thc lollowing as applicable: � � SSS��� <br /> • Property Lines • Centerline of slreet ♦A m � <br /> • OuUine and dimensions ol all existing and • InAicate North V� � <br /> proposeA structures on'he bl • Show any proposed grading cha�ges <br /> • Eaisting and proposed utilities • Show measurements /M � <br /> W �' � <br /> DO NOT WRITE BELOW THIS LINE O �Qy zy <br /> PERA111 CONDITIONS �-t"i �-s. <br /> 7. All oalls�or inspection shall Ue made 2A hrs. in ad�ance-phone 259•881 5. � � N <br /> 2, All work shall be p^-rformed in accordance with Ihis permit and current City of Evere;t Design and Construction O � <br /> Standards and Specilications. �7 <br /> 3. Call Localion Underground Service 48 hrs. bebre you dig.TOLL FHEE NUMBER 1•800•424-5555. � � <br /> H <br /> /UO Ava��c /�o�=',Es r'������i ,�9u�.�E� � � <br /> � N <br /> . �,.. � <br /> � <br /> s <br /> - T�a <br /> � � <br /> a � <br /> � <br /> � <br /> M <br /> ACKNOWLEDGEMENTOFCONDITIONS � <br /> The undersigned ownedappliwnt hereby agrees to hold and save harm- <br /> less the City of Everetl Irom any and all claims lor damages, cosis, <br /> eapense5, or Cau5e5 0l aClion �hat may .fise UCCause of in5talla;ion <br /> and maintanance of lhe improvement :r other ri9ht-ol-way rse he�eto <br /> applied tor and Wrther agrees to rr.move same upon noCce Irom �he <br /> Approved for Construdion Date City and to replace puUlic property oamegetl ihereby. <br /> FINAL INSPECTION ���e � Date <br /> Approved as Consiructed Signature of AFPlicant <br /> WOHK 4UTHORIZCC BY TH'S pERMIT IdUST BE ST4RTED WITI�IN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATc PERMI7 �S ISSUED AND THEREAFTEH IS TO <br /> � °200 Cedar Street B[ DILIGENTLY PURSU[D TJ COMPLETION.THIS PERMIT A4P'i 9E <br /> Everett,WA 98201 CANCELLED BY THE GTY UFQN ANY STOFPAGE OF WORY,O'J l�IS <br /> Phonn: 259-8815 PROJEC?OV[R 90 DAYS DURATIO�: <br />