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,, <br /> �{- 18-89 -' <br /> Date— �.,. �v�,...��.,. <br /> AUPI�[atien far e��+a ��•n� . �_ p��_— . <br /> PUBLIC WORKS PERMIT ��°�����w°������ ------- - <br /> ��„��Pa s_ _ <br /> l��ss Ann� �e�PnN S <br /> Print or Type Only ea�.,�,�o,.� s _ <br /> i�riu ►Yl�._v�n �i� �Ri.���-}..�� LT <br /> O ner Madmy AAdress Cit� y _�p Phone <br /> Apphcant Maihng AAdrpss Gty Zip PhOnO <br /> Describr. Proposed Wcrk � ��{/rY, `���' u�Y a <br /> fl��Q�l ' <br /> Proiecl ACtlress 1�1 known� a�aa � <br /> � <br /> Attach lour 141 copies ol ulans lor o�oposed work� Draw to scale and nole Ihe lollowing as anPGcable: � <br /> • Properry lmes • Cenlerline ol street � <br /> • Out6ne and dimensions ol all e.�sUng and • Indicatr. North <br /> proposeA slructures on ihe lol • Show any proposed grading changes <br /> • Ekist�ng ana proposed ulilities • Show measuremenis � <br /> DO NOT WRITE BELOW TMIS LINC <br /> PERMIT CUNDI710NS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8870. � <br /> 2.AII work shall be peAormed in accordance with this permit and current City ol Everett Design and Construction <br /> Stendards end Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER�-800•424•5555. � <br /> rlor ���. � <br /> ,=���,�.-� <br /> �� :U"- �� �' <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unAersigneA owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Gty o� Everett Irom any and all claims br damages. costa <br /> expenses. or causes of action Ihat may arise because ol installation <br /> anA mamlenance of ihe imprcvemenl or other right-of-way use hereto <br /> apphed lor and further agrees to remove same upon notice from the <br /> Approved loi ConsnucUon ���e City antl to replace pub6c property damaged ihereby. <br /> FINAL INSPECTION Datc <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTkiORIZ[D BY TIiIS PERMIT MUST BE STARTED WITHIN <br /> everrtt PUBLIC WORKS DEPARTMENT 1p0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE �IUGENTLY PURSUED 70 COMPLETION. THIS PERMI7 MAY BE <br /> Everell,WA 9A201 CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />