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Date _"���'",� .� • �„��.���,,,.,�,., , �, f � .J _ <br /> At>Ulir,aiion For biao oen� . ����� 1�� <br /> PUBLIC WORKS PERMIT F������=w���s«� -- - - <br /> .o���F�� s_. <br /> loss Pnui �ce Pa�U $ <br /> Print or Type Only e.,�,�«o�„ s <br /> � � <br /> �,;��r]CA►� ) �t�2C� �a �1' �.�r� ��?U I ���'J�� _ �� , — <br /> OWner Mailinc�AAtlrc55 Cily Zip Phone <br /> � K <br /> Apphcan� Mnilinq Addre55 GIy Zip Phone <br /> Qescribe Proposetl Wnrk <br /> Tn r��� I T . ,��i1x`��L�J_"?�L�'�` � _ <br /> � <br /> Prolect Adtlress Id knownl . . ? ~ � !" `c� � <br /> Attach four(�I coUies o�plans fpr proposed wOrk� Draw to scale and note lhe lollowing as apUllcable: � <br /> • Property Lines • Centerline ol strect � <br /> • OutGne and dimensions ol all existing 2nd • Indicate North <br /> proposetl structures on Ihe lot • Show any pruposed grading chanpes <br /> • Exisimg and proposed uti6ties • Show measurements � <br /> DO NOi INRITE BE�OW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with�his permit and currrnt City ot Everett Design and Construction <br /> S�andards and Specilir.ations. <br /> 3.Call Localion Underground Service�8 hrs,before you dig.TOLL FREE NUMBER 1-$00-424•5555. �� <br /> �(� � / , O <br /> ' .-�;/,�,..-/>-: <br /> y,_ �_3— ��7 �' <br /> V♦ <br /> O <br /> a <br /> ACKNOWLEDGEM[NT OF CONDITIONS <br /> _ __ The undersiqned owner/applicant hereby agrees to hold and save harm� <br /> — less the City ol Everett from any and all claims lor damages, costs. <br /> expenses, or causes of action that may arise hecause ol installation <br /> �nd main�enance of Ihe impiovement or o�her right�ol�way use here�o <br /> — applied for and lurthci agrees �o remove same upon nohte ��om the <br /> Approved lor Conslruction D��e City and Io repince puhlic proP��ty damae�ed ihereby. <br /> FINAL INSPECTION Date <br /> Approved as CU�istruCled Signalwe ol Applicant Date <br /> everPtt PUBLICWORKSDEPARTMCNT �NORK AUTHORIZED BY THIS PERAfIT MUST BE STARTED N'ITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERAAIT IS ISSUED AND TIiEREAFiER IS TO <br /> Everett.R'A99201 BE DIUGENTLY PURSUED TO CC" 'IETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED �Y THE CITY UPON i.�. ;TOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURAT �n <br />