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Date ��' 7 � ��,�„��� w���.sr�,m��. /' D/ <br /> ��'V uioa ocr:i.. —�',.�-l-L-�-��'1-- <br /> Applicntion For � � <br /> PUBLIC WORKS PERMIT Pu`�Totaliearen 5 <br /> Less Apol fee PaiC g <br /> Daiencn�ue S_ <br /> Print or Type Only <br /> —� h� d! � !�.;c� ( ���' -�`'� �i- fC ) .EyP�Pi'f rl�Zd� 347 -/�r� 3 <br /> p�e� MadingAddre Ciry Zip Phono <br /> SG„� � <br /> Applicant M�iling Address City 2ip Phone <br /> Describe Prop�:sed Work ...�e11t�a-.YJ47nrG.(�A��u��4���-� �� � i�I6C ""�� ���0 <br /> �.l� � q` �L':-m-4.q �'- f��,�rji N G;N <br /> �] W <br /> Prolp��Address(il known) )�z� �!/��' P/ /Tl�� � <br /> At�ach lour(4)copies ol plans lor proposed work• Draw to scale and note the lollowing as applicebie: � <br /> • Pwperry lines . • Cenlerline ol street � <br /> • Oulline and dimensions oi all ezisting and • Indicate North <br /> proposed structures on the bt � Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � �� <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls lor inspection shell be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in eccordance wilh this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground&ervice 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5S5S. � <br /> /'�Udc�c ui,•,��r r�.�A,,,,,- nioT .�'EC,��>,:Yo `��o/y'7 O <br /> `�!.''li <br /> � <br /> � <br /> O <br /> a <br /> AChNOWLEDGEMENT OF CONDITIONS <br /> ihe undersigned owner/applicant hereby agrees�o hold and save harm• <br /> leas the Cily ol Everett irom any and all clai�..s for damages, cosls, <br /> ezpenses, or causes ol action that may arise because of instellation <br /> and maintenance ol the improvemenl or other right-of-way use hereto <br /> . applied lor and furiher agrees to remove same upon nolice from ihe <br /> Approved loi Construclion Date City and to replace pub4c property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Gonstructed Signature ol Applicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WI7HIN <br /> everett PUBLIC WORKS DEP4R7MENT 1B0 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everell,WA 98201 CANCELLED BY TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 pROJECT OVER 90 DAYS DURATION. <br />