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Datc_��Y�� 0 � •,��,���v,��„�,., 1�'���� _� <br /> ApUlicalicn For ❑��+o o�•oi . _��OC.,,�_�__ <br /> PUBLIC WORKS PERMIT �,�,����W�;�t���-- - - - --- - -- <br /> to�e�1'rr s <br /> 1e55 P�tpl l��rv 1'AiJ S <br /> PriM or lype Only °T�"°`rpor s� <br /> ��ae�i�,����� ��1�1�i 1-��c� �ga��_ I <br /> Owne� MaLng AtlA�i•ss Cdy Zip Phone <br /> �;a�-g ��� ' <br /> � <br /> ApPlitanl MaJmp Atldios; CdY �—�— Zip P�onC <br /> Descnne Proposed Wo�k .�� v� _ <br /> Prolect Address lil knowol �v�� �JL�I�Ve�� AVE- � <br /> � <br /> Atlach lour(41 copies ol plans�or proPosetl work- Draw to scalc and note Ihe lollowing as applicable: � <br /> • Propeny Lmes • Centerline ot streei � <br /> • Outhne and dimensions of all eaishng and • Indicalc Norih <br /> proposetl strudures on the lot • Show any propoSeA gratling changes <br /> • EzisLng and oroposed utilAies • Show measurements � <br /> DO NOT WRITE BEIOW THIS LINF. <br /> PERMIT CONDITIONS O <br /> 1.All calls loi inspection shall be matle 24 hrs.in advance-phone 259•8b��. � <br /> 2.All work shall be peAormed in accordance with this Aermit and current Ciry of Everett Design end Constmction <br /> Standards end SDecilications. <br /> 3.Cell Location Underground Service 48 hrs.belore you dig.TOLL F9EE NUMBER�-800�424•5555. � <br /> O . <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGCME��i OF CO�IDITIONS <br /> ihe undersigned ownc�/apph��n.i1 hereby agrees to hold and save harm- <br /> Icss the City ol Everett Irom any and all claims for damages, rosts. <br /> e.penses, or causes ol aclion Ihat may arise because of ins� � �,.'�on <br /> �.� q� and maintenance ol thr improvement or other right�obway usF •,�•:tu <br /> L apPlied �or and lurthei agrees lo remove same upon notice • �m • �e <br /> Ap r ed lor Cons �clioi Date Cdy and to repiace pubhc property damaged ihereby. <br /> � <br /> ��lt-C�---.. �./7-ya <br /> FINAL INSPECTION Date �� ���w� I-'y�O <br /> Approved as Constructed Signature o�pplic nt Date <br /> everetl PUBLIC WORKSDEPARTMENT WORK AUTHORIZ[D BY THIS PERASIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA99201 BE DILIG[NiLV PURSUED TO COMPLETION. THIS PERMIT MA1' BE <br /> phone�,259-8810 CANC[LLED�V 7H�CITY UPON ANY SYOPPAGE Of WORK ON THtS <br /> PROJECT OVEH 90 DAYS DURATION. <br />