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Date��7�': ��� <br /> Puei¢Wo�ks Pe�mit=C <br /> Ppplicatian For eiea oeoi.• �P. � <br /> PUBLiC WORKS PERMIT Pu01¢WorYsiee <br /> Tolal Fce s <br /> Lass A00��Fee Pn�� S <br /> Print or 7ype Only ea�a��eo�P s ZO�— <br /> 1� I 1 � � _ ��,r^� ���,�,n S-�, � �� ��r��- ���an� ���-i�� <br /> Owner � � � Mailing Address City 2ip Phone <br /> r �/� I <br /> �/l � I���� ��-`j'� r� `:� 'r�"/�_ I i� Y-"T� r?���—�'f_ .� ����—����7Y' <br /> Applicant l_i Mail�ng AAAress City Z�p Phone � <br /> Describe Proposed Work ���� <br /> W <br /> Project Aadress lil known) -��28 — �Q-C�GP<u-� L <br /> Attach four(4)copiee ol plans lor proposed work- Draw to scxle and nole the lollowing as apUlicable: � <br /> • Properry Lines • Centerline of str�el � <br /> • Outline and dimensions ol all exisf^g and • Intlicate North <br /> proposed slructures on the lot • Show any proposed gradine7 changes <br /> • Existing and proposed utilities • Show measureme:•4s � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259•8870. � <br /> 2.All work shall be per�ormed in accordance with this permit and current City ol Everett Design and Consiruction <br /> Standards and Specifica�ions. <br /> 3.Call Location Under�round Service 48 hrs.betore you dig.TOLL FREE NUMBER�•800•424•55$$. � <br /> O <br /> ■ <br /> � <br /> O <br /> a <br /> �p ACKNOWLEDGEMENT OF CONDITIONS <br /> ��� The undeisigned owneVapplicant hereby agrees to hold and save harm� <br /> less Ihe City of Everett trom any and all claims lor damages, costs, <br /> eapenses, or causes of aclion that may a�ise bewuse ol inslallation <br /> //�/ 0�9 and meintenance ol ihe impruvement or other right-of�way use hereto <br /> � u applied lor and luriher ac�rees to remove sar�u upon notice Irom the <br /> Approved lor C � ction Date City and to replace pu �c property d2maged Ihereby. <br /> �l /v_ 7J-�% _ �-L`n� �,L � 7 � <br /> FINAL INSPECTION Date <br /> ApProved as Consiructed Signatwe Applica Date <br /> evemtl PUBLIC WORKS DEPARTMENT WORK AUTHORIZ[ IS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSU[D AND THER[�FTER IS TO <br /> Evrrett,Wq g8201 BE DILIGENTLY PURSU[D 10 COMPLETION. THIS PERMIT MAY �E <br /> Phona 259�BP10 C�NCELLED BY THE CITV UPON ANY STOPPAGE OF 1NOfiK ON THIS <br /> PFOJ[CT OVER 90 DAYS DURATION. <br />