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- , � n�oec�v�,.s r�,.���.i. — _ <br /> Date�' ema oeoi • 9—������i�— <br /> Applica�ion For _ <br /> PUBLIC WORKS PERMIT °.�°"`"'°'""e< S <br /> iU1P�VPC <br /> L�•s;5n�l FeeFaut 5 <br /> o:i.,���n�� 5— <br /> ��y Print or Type Only <br /> G�H 0 � '�� L � �7 � ? �� %�c� / �Sc�— 7.J�" �S _ <br /> 9 H V� z n Pnone <br /> +�C MaJm AdAress ��Y <br /> t y Owner 9 <br /> Hxl-�i <br /> FC C] - <br /> �O H� Mailin9 Adtlress City Zip Phone <br /> "'APPlicant <br /> q�H �_ <br /> Eij p� Describe Proposed Work _— <br /> H <br /> � H — <br /> C'1 <br /> �� � W <br /> zy� / � <br /> � H y Prolect Address lil knownl �/ � <br /> y � <br /> H Attach lour(4)�opies ol plans lor proposed work� Draw to scale and note the�ollowine�as apUlicable�. � <br /> �dC�y • Proper�y Lines • Cente�line ol streel <br /> ��J r • Oulline and dimensions ol all ex�sting antl • Indicate North <br /> i proposed slruciures on ihe lot • Show any proposed 9retline�changes <br /> x y y • Existing and proposed utilitics • Sl�ow measurements /� <br /> H O:� W <br /> � DO NOT WRITE BELONJ TNIS LINE O <br /> V��/ PERMIT CONDITIONS <br /> i �7.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8870. <br /> i 2.All work shall be pedormed in accordance wilh this perm�t and current Ciry of Everett Design and Constmctio� <br /> � —� SlandardsandSpecifications. <br /> ` 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ' �� �%i.�fzG Ctt'�y�'�-' :,�»...-�/L�i:':�Z.� �i.��� � .. . . , � <br /> I -� `' F- <br /> ';;:; �,�r,� �- <br /> • V♦�� =' % -i;�. <br /> �' � � � a <br /> !_I�i <br /> ACKNOWLE�GEMENT OP CONDITIONS <br /> ��� The untlersigned owner/applicant h..reUy agrees to hold ana save harm� <br /> . less the Cny ol Everett Iwm any and all claims for damages, cosis. <br /> expenses. or causos ol action that mny arise Uecause ol install3Uon <br /> - and maintenance of 1hc improvement o� other riyhl�obway use herelo <br /> applied lor and lurlher agrees to remove same upon notice Irom the <br /> Approved lor Construdion ���e Cily and to replace puU6c property damaged Ihereby. <br /> FINAL INSPECTION Date Dalc <br /> Appmved as Constructed S�gnature o�APpliwnt <br /> WORK AUTHGRIZED B� THIS P[RMIT MUST 6E £7ARTED WITHIN <br /> evcrett PUBLICWORKSDEPARTMENT I 180 DAYS OF DATE PERh11T IS ISSUED AND TH617EAFTER IS TO <br /> � 3200CedarStreet OE DILIGENTLV PURSUFD TO COMPLETION.THIS Pl'.RIdIT hiAV BE <br /> EveretL WA 90207 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WO�iK ON THIS <br /> Phane:259�8810 pROJECT OVER 00 DAYS DU�7ATION. <br />