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Date�_v� ^ � r�m.�wo,ksv �mn. <br /> Biag Geo��• <br /> Application Fnr <br /> PUBLIC WORKS PERMIT '°°"°W°�'°°a° -- <br /> Tata1 Fee s— <br /> Less ADO�Fea Peid s — <br /> BalanceDue S <br /> Print or Type Only <br /> �N�v �'���v 2-1 C,"G ' 1►�r'YU'� �.t J�F�FtT .�5�--��1f7 <br /> Owner Mailing Address City Z�p Phone <br /> ��ar�� «S�r ��� i i�-i�'�� �vr ���,�.�v �53�4 "�j � <br /> Applicflnt Mailing Atldress City Zip Phone <br /> Dascribe Proposed Work �� ��� ��rC PL���Q ���� r,�l'�� - - <br /> i' <br /> --- LLI <br /> Prolect Address(il known) �� c � 1��^�— � <br /> Attach four(4)copies of plens lor proposed work- Draw to scale and note the Ioilowing as applicable: � <br /> • Property Lines . • CeNerline ol sireet � <br /> • Oulline and dimensions oi all existing and • Indicat?Norlh <br /> proposed stn" �-•d on the lot • Show ai;;proposed 9rading changes <br /> • Existing end p�oposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PEFMIT CONDIT101JS <br /> 1. All cails lor inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shetl be perlormed in accordance with ihis permit ana current City of Everett�esign and Consiruclion <br /> Standards and Specilicetions. <br /> 3. Cell Location Underyround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> �cl<�c� lck��r- �2rn.:-f/���F9- _ j��`5'� O <br /> — �� <br /> � <br /> � <br /> O <br /> . a <br /> ACKNOIVLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicaM hereby agrees to hold and save he�m- <br /> less the City ol Everetl trom any and all claims lor damages, costs, <br /> ezpensr.�, or causes of action ihat may arise because ol installation <br /> and maiNenance of the improvement or other right-ol-way use here!o <br /> applied lor and furiher agrees b remove same upon notice from the <br /> Approved for Construction �a�e City and lo replace public properry damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTF.D WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Str�et BE DILIGENTLY PURSUED TO COA�PLETION.THIS PERMIT MAY BE <br /> Everell,WA 98201 C.4NCELLED HY THE GTY UPON AKY STOPPAGE OF 1VORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAVS DURATIOIv <br />