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Date��l r�o�,�wo,�s Pe�m��. <br /> / Apphcation For oiap oeo�.•�]� �;,p'�.3`, <br /> PUBLIC N►ORKS RERMIT ruOTotlFeeFe^ S <br /> Leee Appl Iee Paid S <br /> Bnlencx Oun S— <br /> Print or Type Only <br /> � <br /> 7�+c��nJ � ��.,�,Y�_511,�i�x.c�c.o�l4�e �veintf �iA'ln� asa-�a�_— <br /> �wner Mailing Address Cit; Zip Phone <br /> Sn wi p - <br /> Applicant Mailing Address City Lp Phone <br /> Descnbe Proposed Work � r"J X��(Y`�/Y�✓)C/ll. Qe]_QCJS/�rYL9—�j�'(,(a�/ �1� <br /> T <br /> W <br /> Project Addres5lil known) � r+ • �� (� �� ��' � <br /> Attach four(a�copies ol plans for proposed work- Draw to scale and nole the following as applicable: � <br /> • Proper�y lines • Centerline of stree� � <br /> • Outiine and dimensions o1 all existing and • Indic�te North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Ezis�ing and proposed utilities • Show measuremenls M i <br /> DO NOT WR�TE BELOW THIS LINE � � <br /> PERMIT CONDITIONS O i <br /> 1. All calls lor inspec!ion shall be made 24 hrs. in advence-phone 2rJ9•88�S. � <br /> 2. All work shall be performed in accordance with ihis permi�and current City of Everett Design and Consiruction <br /> f'ilandards and Specifications. <br /> 3. Call Location U�derground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> I�UB/Jc �.�,C�s /����,r �T ,PEn,�-r.�<� /"a-3/9,' � <br /> � _ ,.n�G � <br /> �.. <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appli�ant hereby agrees lo hold and save harm- <br /> less ihe City ol Everetl Irom any and all claims br damages, costs, <br /> expenses, or causes o1 aclion ihat may arise because ol installation <br /> and maintenance ol the irrprovement or other right-ol-way cse hereto <br /> applied for and turiher agrees to remove same upon notice irom the <br /> Approved lo�Construction �a�e City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature ol Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 780 DAVS OF DATE PERMIT IS ISSUED AND THEREAi fER IS ?O <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA'.' BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�BB15 PROJ[CT OVER 90 DAVS DURATION. <br />