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, <br /> Datr. / � � ���n�,�wo,�.�.�m,�. <br /> Application For eieo oeo�.• F � ��r�•'Z� 7 <br /> PUBLIC WORKS PERMIT Publ�cWorh�Foe <br /> iotel Fee S <br /> lB6s Appl.Fea PeiG s <br /> Print or Type Only e��e���o�, s <br /> �r�� I I�,�� tou �3G1 %:ur_� ai /�UQ � .iriP �J��1D 1 <br /> Owner r Mailing Address City 2ip Phone <br /> �Jn�y rp�Ac 't_ ��D ti�x 31�j �'l��ys✓, llP y��?() Car �j —�13G,� <br /> Apphwnt idalling Address � City Zip Phone <br /> Describe Proposed Work ' L <br /> W <br /> , �Prejec!Address(il known) <br /> Attach four�4)copies ol pi2ns for proposed work•Oraw lo scale and nole the following es applicable: � <br /> • Property Unes • Centerline of street � <br /> • Outline und tlimensions ot all existing and • I�dicate North <br /> propcsed,huct�res on Ihe lot • Show any pioposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> ;. All cells for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shell be peAormed in accordence with this permit end current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location UnderQround Service 48 hrs.betore you Aig.TOLL FHEE NUMBER 1•600•�{Z4•rJ555. � � <br /> �� .S�9-�7 7 O i <br /> /-��BL�G LcJO.e�tS f E:Ci�•T 11�CT �f��'�.eF� i <br /> ��� ' <br /> � -" � ; <br /> V� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> less the City ol Everet� Irom any and all claims for damages, costa <br /> expences, or causes of action that may arise because of installation <br /> and main�enance ot the improvement or olher rigM-of-wey use hereto <br /> applied lor and furlher agrees to remove same upon notice from the <br /> Approved lor Construction Date Ci[y and to replace public properly damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved es Constructed Signature of ApplicaN Date <br /> everett PU6LIC WORKS DEPAATMENT WORK AUTHORIZED BY THIS PERMIT MUST BE START[D WITHIN <br /> � 3200 Cedar Slreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eveiett.1NA 98207 BE DII.IGENTLY PURSUED TO COMPL.ETION. THIS PERMIT MAY BE <br /> Phone: 259�8fl 15 CANCELLED �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> f'ROJECT OVER 90 DAYS DURATION. <br />