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J� � <br /> �.��� L � � , � PupLc Wak�Pnrmi��.�,{— J v <br /> AppliCation For D�av Dcai.• �__ �._�r!Q� <br /> PI�BLIC WORKS PERMIT rbTotNfavFec g --__ <br /> Le�sAppl feePpiO 5 ��q / /J���• <br /> Bmance Uue S lYll�. �"'� <br /> Print or Type Only ,o <br /> f�C�E".�j�PAiO. <br /> .rr�AC-�EL 1�D r��X 1�3 p�i!�r� rL-'O u1a �a.�S � ��s� 1 <br /> Owoer Malling Address C� Zip Phone <br /> �'`� l�r - - - <br /> App!icant MaJing Address Gity Zip Phone <br /> Describe Proposed Work �v�w Jr� — — <br /> // W <br /> Project Atldress(it known) �r�� � ��� � <br /> Mtach four(4)copies of Plans lor proposed work• Druw to scule and note the lollowing as applicable: � <br /> • Pruperh�Lines . • Centerline of street � <br /> • Outline and dimensions of all eKisling and • Indicate Norih <br /> proposed structures on the lot • 5how any proposed grading changes <br /> • Existing end proposed utilities • Show measurements � <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS ,���onO� <br /> 1. All calls tor inspection shall be mede 24 hrs in advarce-phonu�.�- U�� � <br /> 2. All work shall be peAormed in accordance with ihis permit and current City of Everett Desl �and Construction <br /> Ste�dards and Specifications. <br /> J. Call Location Unde�ground Service 4B hrs be'ore yau dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> � �� The�nd�rsigned owner/applicant hereby agrees to hold and save harm• <br /> less tl.e City of Evered trom any and all cloims lor damages, cost4 <br /> /���r_ espenses, or causee o� action ihat may arise because of installation <br /> S 5//8� and mamtenance ol ihe improvement or other righbof-way use hereto <br /> applied for and lurther agrees to remove same upon notice Irom lhe <br /> Approved lor onsir clron ' � Dale Cily and to replace pu6lic property damaged thereby. <br /> i , � � Q <br /> ,���i�'!�%� � ��` ��� � ��i�,��..� /f �� ,P-7 <br /> FINAL INSPECTION Date , . � <br /> Approved as Const�ucted �SignaWre ol Applicant ���e <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBIIC WORKS DEPARTMENT 180 DAYS O� DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> Evere��,WA 98201 ^ CANGELLED BY TIiE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:-Ns9S�r5 ;��-�C�v pROJECT OVER 90 DAYS DURATION. <br />