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C/,c� <br /> --. <br /> Date — y0 D �„�����•,�,.,v�,m,�. <br /> Appllcation For o1°0 0`�� '—'—"�-���� <br /> P'l1BLIC WORKS PERMIT P°"°",°«9FCe -- <br /> ro�r�F�e s <br /> less Apo�fee Pa�a S <br /> Print or Type Only ea�a�=e o�� s <br /> �''-I�-►'� d12h1�� �31 RUC;�.I�' ���'��" � l �8-��� <br /> Owner Mailing Address ��� Cily Zip Phone <br /> �t�Pr� �Yi�[ a � Si�l+e '�b3 I I�� � C'r��� �,-��-y5`� <br /> Applica�� Mailin��A dress City Zip Phone <br /> Describe Proposed Work _ �� ���I 1 <br /> W <br /> Prolect Address lil known) � <br /> / <br /> � Attach tour(4)copies ol plans lor proposed wurk- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed struclures on ihe lot • Show any proposed gradinr� changes <br /> . • Existing and proposed utilities • Show measureirents � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be perormed in accordance with ihis permit and current Ciry ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> C�t 1�U I� ,� O <br /> .'�-� -�g � <br /> � <br /> � <br /> a <br /> �CIWCWLEDG[MENT OF CONDITIONS <br /> The midersigned owner�apPlicant hereby agree5 to hotd and save harm- <br /> Iess the Cdy ol Everett Irom any and all claims lor damages. costs. <br /> expenses, or causes of action ihat may arise because of installation <br /> and maintenance ol the improvement or other right�obv+ay use hereto <br /> applied for and lurther agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Gonstructed Signatwe of Applicant Uate <br /> everell PUBLIC WORKS DEPARTMENT WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARiED WITHIN <br /> 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERti11T MPV B[ <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI� <br /> Phone:259-8810 PROJECT OVER 90 DAVS DURATION. <br />