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Date��� �„�„�w�..,���,m,�. /��>� <br /> AiOu DeN • L_�V-� <br /> Applicallon For <br /> PUBLIC V1lORKS PERMIT "°"'""'°'"``°° - <br /> ,o�.�.�s s <br /> l!s+ADN iee Pa�E s <br /> Beixncc�ue S <br /> Print or Type Only <br /> �c„��o�. rn� . { - Zzu ��f,►���. ��� zsZ-9��s4 <br /> Owner � Mailing Addiess Gdy Zip PhOne <br /> SApp���� Mailing Atldress Gly Zip Phone <br /> Describe Proposed Work F.LSLOl.o �� � 1��p r p������ a—"""--"�� <br /> �---_ _ — W <br /> Prolect AAOress Id knownl — � <br /> � <br /> Atlach lour(4)copies of plans for proposed work� Draw to scala and note Ihe lollowing aa applicable: � <br /> � Property Lines • Centerline ol street <br /> • Outline end dlmensions ol all existing and C Indicate North <br /> proposed structures on the Ioi • Show any proposed grading chn�ges <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WFITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1,qIi calis tor inspection ehall be mede 24 hrs.in advance•phone 259•Sk310. <br /> 2.All work ahell be peAormed in eccordance with this permit and current City of Everett Design and Construction <br /> Ste�ards and Specificetions. � <br /> 3.Call Locetion Underground Service 48 hrs.before you dig.TOLi FR[E NUMBEH 1•800•424•55$5. <br /> �C/6—179 O <br /> ��- wv�-/�..�.:,(.t.b�`,e��z.�P 5 f� <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedappGcaM hereby agrees to hold and save harm- <br /> -- Iess the City ol Fverett Irom any and all daims lor damages, costs, <br /> expenses. or cauees ol action that may arlse because of inslallation <br /> and mainlenance of the improvement or other righbol-way use hereto <br /> applied br and lurther agrees �o remove same upon notice Irom the <br /> Approved tor Construction �a�e City and to replace pubhc proPerty damaged ihereby <br /> FINAL INSPECTION Date pate <br /> Approved as Consiruded Signature of Applicant <br /> WORK AUTHORIZ[D BY THIS PERMIT MUST BE StARTED WITHIN <br /> everM� PUBUCWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND TH�4EAfTER IS TO <br /> � 3200 Cedar St�eet BE DILIG[NT�Y PURSUED TO COMPLETION.THIS PERMIT MAY BE ' <br /> Everelt.WA 98201 CANCELLED DV THE GTY UFON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.25P-B810 PROJCCT OVER 90 DAYS DURATION. <br />