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i <br /> � <br /> ��>' .�r�- _>✓-: <br /> Date � n� PuElrcWorkaPermi�� <br /> Application For o�oq ocoi •.�G.�_l�l—I.�� <br /> PUBLIC WORKS PERMIT P°°��°�°°«,°�° <br /> .o�r�F�e s � <br /> Less AOP�.Fee Pa�� 5 <br /> BaianceDvv $ �� �I <br /> Print or Type Only <br /> I <br /> rn�r �rv�r�� , �� ��i-nv� il ��llii��'1 �n�� 1 ����� � �(-',i�� � � ��a-.�I`�� � <br /> QW�,;� �A�ig ddress City Ph.one <br /> `�iL.� fil�tr ������ �a ir��< � ��. ��kv_ ur �r.��� ���-�a� <br /> ApplicaN Mailing Atldress Cdy Zip Phone <br /> Describe Proposed Work ___L].i Q � � �.t!'�C �n� � I � ��^�' � I -- <br /> 1 <br /> W <br /> Prolect Address lil knownl ��C — ��/��� �//�/-C.� ni(�, � <br /> Altach tour 14)copies ol plans lor propos=d work- Draw lo scale and note Ihe following as applicable: � <br /> • Property Lines • Cenlerline ol slreet ♦� <br /> • Outline and dimensions ol all ezlsting and • Indicate North V� <br /> proposed slrucW res on Ihe lot • Show any proposed gradinq changes <br /> • Ezisting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE 9ELOW THIS LIN[ O <br /> PERMIT CONDITIONS <br /> 1.All calls for�.nspection shall be made 24 hrs.in advance-phone 259•8810. �\ <br /> 2.All work shall be pertormed in accordance with ihis permil and cwrent City of Everetl Design and Conslruclion ♦ <br /> Standards and Specificalions. <br /> 3.Call Location Underground Service 48 he.before you tlig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> �w <br /> �/ <br /> O <br /> a <br /> ��� �CKNOWLEDGEt.1ENT OF CONDITION` <br /> The undersic�ned owner/applicant herehy ag�ees to holi . .ave h,3rm� <br /> � less the City of Everett hom any and all claims lor •� i�es, costs, <br /> �� � expenses, or causes ol aclion that may arise bcaausi ., installation <br /> �, �� ✓ </ � and maintenance ot the improvemenl or other right-obway use here[o i <br /> ���� r � �� applied lor and further agrees lo remove same upon nolice Irom ihe <br /> Approved for Const� n Date Ci„ d to replace public roperfy damaged ihereby. <br /> FINA IN CTION / ^�-`Date �� �� �`/O—��y <br /> App�oved as Construcicd ignature ol Applicant Date I <br /> rvei�tl PUBUCWORKSDEPARTMENT WORK AUTHORIZED DY THIS PERMIT MUST BE STARTED WITHIN �I <br /> � 180 DAYS OF DATG PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> 3200CedarStreet B[ DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA98201 CANCEL'.ED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> phone:259�6810 PROJEC�f OVER 90 DAYS DUR�ITION. <br /> I <br /> i <br /> � <br />