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� � / <br /> Date � � r�eer.wo�ws r�im�i. �/� <br /> Application Far PIJp o�ai .�� <br /> PUBLIC WORKS PERMIT ruei�cWmtaree <br /> TOIRI�P.p S <br /> Lese ApVI fpc PTi� ?S <br /> 8d1�lnC�!�u� V �^ <br /> Print or Type Only <br /> Skellr� S,Kyn.r /3�oZ l�uc�nr � l�veit� I�d.zo�/ aS'�--J��— <br /> Owaer � Mading Atldress City Zip Pho�r <br /> Gvoo�e r�d,nh.c� �1�� � —�eo'`� S�' nIC �„4�s�v�nsGUr� Qdotsd' <br /> App�icant Mailing Address Cily Zip Phone <br /> Describe Proposed Work `�N�S � <br /> Prolect Address lif known) /3aa Ru r.l e� � <br /> � <br /> Attach lour(4)copies ol plans br proposed work•Draw lo scale and note ihe lo�lowing as ap0licable: � � <br /> • Property Lines • Centerline ol street � ! <br /> • Outline and dimenslons ol all ezisting and • Indicate Norih i <br /> proposed structures on the lot • Show any proposed grading changes <br /> • ERisting anC proposed utilities • Show measuremems � I <br /> DO NOT WRITE BELOW TH�S LINE �� <br /> PERMIT CONDITIONS O I <br /> 1.All calis lor fnspection shall be made 24 hrs.in advance•phone 259•8810. � i <br /> 2.All work sheli be pedormed in accordance with this permit and current City of Everett Design and Construction + <br /> Stendards end Specifications. I <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424-5555. � � <br /> O ' <br /> � � <br /> � I <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDI710NS <br /> The undersigned owne�/apFlicant hereby agrees to hold and save ha�m• <br /> less the Ciry ol Everett Irom any and all claims for damages, cosis, <br /> expenses. or causes ol action thal may arise because ol instal:ation <br /> � �_ !�./ZS and rnaintenanr.e of Ihe imp�ovement or other right-of-way use he�eto <br /> applied lor and lurther agrees to remove same upon notice I�om ihe <br /> Approved loi Constructi Date City and to replace public proper y tlamaged thereby. <br /> � �" y=.;� �-9n ��/J� }�, T <br /> INSPEC ON Date /�� y � `'�� �v <br /> ApprOved as Consiruded Signature ol Applir,ant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTIiORIZED BY THIS PERNIT tJIUST BE STARTED WITHIN <br /> � 1B0 DAYS OF DATE PERMIT IS ISSUE�) AND THEREAFTEfl IS TO <br /> 3200 Cedar Slreet BE DILIGENTLV PURSUED TO COMPLfT�ON. TNIS PENMIT MAY BE <br /> Eveiett,WA 9e20; CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone:259 8810 PROJECT OVER 90 DAYS DI,RATION. <br />