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�8�e�' �� PeOiro Work�P�rmil• <br /> . B�Ep.D�O��• <br /> Applicetion For <br /> PUBLIC WORKS PERMIT `°°TOWF«`°° • <br /> Lese AoO�Fee Pu0 s <br /> B�bn��Dus f <br /> Pri�t or Type Only <br /> ��-}{-�{ S�,►x�k�� <br /> ,-,� � <br /> w�er <br /> MaiFng Address City Zip Phone <br /> � , f� 1�1�. �U� � �'GC',�l'p�-`— `�a'7y( �.� �-S''`7.S <br /> Appl'�cant � �`� MaJmg Address Gry Lp Phone <br /> DescrlCe Proposed Wcrk �;��Lu��.�--T-�� � �� ��+ ��C � �- <br /> W <br /> Project Addrosa(if known) 13�Il (�SA!.�f IP � <br /> � <br /> Attech four(4)copies of plens for proposed work-Qrew to scale and note the lollowing as applicable: � <br /> • Property Linea • Centeriine of street <br /> • Oulline s�d dimensions of ell e�isting and • Indicate North <br /> propoaed structurcs on Ihe lol • Show any proposeA grading changes <br /> • Exitting end proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cNl�for In�pectbn shell be meCo 24 hrs.in edvence�phone 2bP8810. <br /> 2 �����yp p�pa}p�b In�ccord�nce with thls permit end current Ciry ot Everett Despn and Constructlon <br /> St�nd�rd��nd 9p�cMlc�tlo�a � <br /> 3.Cell Lae�tbn UnMrY�n4�^'�48 hre.betore you dig.TOLL FREE NUMBER 1$00�424-5555. <br /> �. ' -TI�.S O <br /> No 6� ��.ev.�.,�t ,,,. <br /> bloek a., w�..4 z,de o�'��e.l— �erv���}" � <br /> � I NITUL I NiPECTION I �r i z c� � <br /> j(IRK�BROOK� ,r,- 3 I -9 y- O <br /> ::-..- ; ,_ , a <br /> OATr -� �`� '� r <br /> �i A.110 `+Ow! Gt�"IYvtl <br /> q � cl r/ � i� ACKNOWLEDGEMENT OF CONDITIONS <br /> y„f � y r U���� Q �- The undersiqned owner/epplicent hereby agrees to hold and save harm• <br /> 0.�I� less Ihe City of Everett irom any and all claims lor damages, costs, <br /> ezpenses, or causes of action that may arise beceuse of installetion <br /> and maintenance ol Ihe improvement or other right-of-wey uae hereto <br /> applied for and further agrees lo ramove same upon notiee from the <br /> Approveo for Gonstructlon Date City and to replace public Properry damaged thereby. <br /> FINAL INSPECTION Date Dete <br /> Signature ol Applicant <br /> Approvetl as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br /> � PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PIIRSUED TO COMPlET10N.THIS PERMIT MAY BE <br /> Everet4 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona:259•BB70 PROJECT OVER 90 DAYS DURATI04. <br />