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_ <br /> i <br /> � <br /> � <br /> Date__1c��.�� P„„„�wo.�.�.., ��—_J.�� <br /> Uinp Oeot.. .�I�.��. <br /> Apphcation FOr . <br /> PUBLIC WORKS PERMIT Pubimw�,�„�e ------__ <br /> ,o�r�Fe� s_-- <br /> Less<nol Fnr Pam $— <br /> AaixnceDae S�n� '. <br /> Print or Type Only — I <br /> , <br /> 'I�Ll`/ � �f�`.J'� I� 1�J� o��' �t �l-�'Y-'� � �I�GL� � �8�-�';�o� <br /> —O,��� Mailingl�tldress Cny Zip Phone <br /> U �1 <br /> AppliGant Mailing dddress City Zip Phone <br /> Ucscnbe Proposed Work � `�'JC��I , 1 ���� ^ � � 1 ��� �� <br /> �� N ( I I( )� /� ���_ <br /> — �� <br /> - W <br /> Proiect Address lif known! <br /> �y�,,�—_ i�i,�'�iti'r9 /���. �" <br /> Attach lour I41 r.opies of plans br proposed work� Oravi to scale antl note Ihe following as apphcabic: � <br /> • Property Lines • Ce�lerline ol streel /A <br /> • Outline and dimensions ot all exlsGng and • Indicale Nor�h V� <br /> proposed structures on�he lot • Show any pr�posed grading changes <br /> • Exi;tmg and propo5ed utilities • Show measure�nen�s � <br /> DO NOT WRIIE BELOW'HIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for�nspection shall be made 24 hrs.ir advance-phone 259•5810. � <br /> 2.All work shall be pertormed in accordance with ihis permit and current Ci�y ol Everett Design and Conslruction <br /> Stantlards and Specitications. <br /> 3.Cxll Loca�ion Underground Service 48 hrs.befoie you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> -- less the City ol Everett Irom any and all claims for dama�es, costs. <br /> ezpenses. or causes of action that may arise because ol ihslallation <br /> i <br /> and mainlenance of the imprm'ement a other rioM•-ot-way use hereto <br /> � � � �' � � appGed lor and further agrees to remove same dpon notice from the <br /> Apnrcved for Con ruclion Date City and to replace public p o1'erty damaged ihereby. <br /> � !e/��/_ 2 /-Ju , � � �, <br /> FINAL INSPECTION Date � � <br /> Approved as Constructed '�i ure ol Appli il / � a�� <br /> K AUTHORI7_ED BY THIS�PGRMIT MUST BC STARTED WITHIN <br /> rverelt PUBLIC WORKS DEPARTtdENT {g0 DAYS OF DATE PERMIT IS ISSUED AIJD THEREAFT[R IS TO i <br /> � 3200CedarStreet BE DILIG[NTLY P�RSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet6 WA 90201 CANCELLED�Y THE GTY UPON A'!V STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 pROJECT OVER 90 DAVS DURATION. I <br /> I <br />