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L.��� Pum�c\vorea Peun�t• `�!�7 3s�o <br /> Date- <br /> emp oeo� • <br /> Application For <br /> PUBLIC WORKS PERMIT "°°:o,:F���Be s_ <br /> luse nno��ro va�e S <br /> ee�nnce o�e S �G� <br /> Print or Type Only <br /> i-�Al7 �IA}7,�Z ���1L`Y�rz� PL S� �i,�r� q�8 ��"1 .�I L9 <br /> Owner Madmg Addr^ss Cdy LP Phone <br /> � � � �/V /� __ <br /> Applicant Mnifing Address City ZiP Phone <br /> Destriba Proposed Work ��l � �� ` � `� �� �� <br /> ��A{,' lE?t,U {� 1��-I1{� <br /> Prole��Address(il known) ��R �E��/Elt� AL�� _� � <br /> Attach lour(4)copies ol plans for proposed work- Draw to scale and nole the lollowing as applicable: � <br /> • Property Lines . • Centerline o1 street � <br /> • Outline end dimensions of ail existing and • �ndicale North <br /> proposed eltuctures on lhe lot • Show any proposed grading ch�nges <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOl WRITE BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for Inspection shall be made 24 hrs in advence•phone Z59•881 5. � � <br /> 2, All work shail be pertormed in accordance with Ihis permit and current City of Everett Design and�onsiruction <br /> Stendards and Specilicetions. <br /> 3. Call Location Underground Service 48 hrs.belore You dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � %iGNT-L i.�/E �OOF'- iG�� f�o//ivS��ou7S io D•F1/�`�G L S O <br /> � <br /> � <br /> O <br /> a <br /> �CKNOINLEDGEMENT OF CONDITIONS <br /> The undersigned owneqapplicant hereby ogrees to hold and save harm- <br /> - - less ihe Ciry of Everett irom any and all claims tor damages, costS <br /> expenses, or causes ol action ihat may arise because of instellation <br /> � � and mainlenance oi lhe improvement or other right�o4way use hereto <br /> �i /� O <��L� applied for and further agrees to remove same upon notice Irom the <br /> Approved tor Consiru i n J �a�' Cil�and lo replace public property damaged thereby. <br /> ��/-fO -�..Bi1-� / ��"�7 <br /> u- <br /> FINAL INSPE TION Date Date <br /> Appro��ed as Constructed Signatare ol Appiicant <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERM'T MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THERFAFTER IS TO <br /> � 3200 Cedar Street BE DIUGENTLY PURSUED TO COMPLETIOIJ. THIS PERMIT MAY BE <br /> Eveietl,N'A 98201 CANCELLED BY THE CITY UPON AN`!STOPf'AGE OF WORK ON THIS <br /> Phone: 259�8875 PROJECT OVER 90 DAYS DUHATIr�N. <br />