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Date� ° � o���,�wo,���o,m, ��y�—?((;�y�;--- <br /> mec o«ni .—�--/--f-','„�— <br /> ApplicaUon For _ <br /> PUBLIC WORitS PtRMIT r�eecwork.ree s <br /> ToiM rea <br /> ll55 FD01 fre Pnd S <br /> Dalance Dox S <br /> Print or T/pe Only <br /> f Fn�_a �j�� (���l' 1 1 �-a� I �A ��I� ` Phone <br /> 't3wne� Maihng Address Z P <br /> �a-Qya3 <br /> Applicant <br /> Mailing Address Cdy Zip Phone <br /> Desciibe Proposed V/ork ��"—} <br /> - W <br /> Prolect AAtlress I�I knownl ��� J I i � ���rP � <br /> � <br /> Attach lour(4)copies o1 Plans for proposed work� Draw to scale and no�e the lollnwing as apphcable: � <br /> • Property Lines • Centerline ol sireel <br /> • Outline and dimensions o! all ezisting and • Indicate North <br /> proGosed structures on Ihe lot • Show any �roposed grading changes <br /> • EKisting anA proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.AII calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work sh011 be perlormed in accoidance wilh this permit and curreM Ciry ol Everett Design and Conslruction <br /> Stenderds and Specifications. � <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> rZ�� ��� r�D Q <br /> J��h� c��� � <br /> �'� v� <br /> l:" <br /> O <br /> a <br /> ACKNOWLGDG[M[Ni OF CONDITIONS <br /> ihe undersianed owner/app�iCaM hcreUy agrees to hold and save harm- <br /> — less the Gity ol Everell Irom any and all claims lor damages, cosis, <br /> erpenses. or causes ol action that may arise because oi installa�ion <br /> and maintenance ol lhe improvement or other nght-ol-way use hereto <br /> applied for and lud.ier ag�ees to remove same upon nutice Irom the <br /> Approved for Consiruction . Date City and to replace pubhc property damaged thereby. <br /> FINAL INSPECTION Date Date <br /> Signature of Applicant <br /> Approved as Gonstructed <br /> WORN AUTHORIZED 6Y THIS P[RMIT MUS7 BE STARTED WIT <br /> evereU PUBLICWORKSDEPARTMENT 1B0 �AYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DI�IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everefl.\NA 98207 CANCELLED BY THE GTV UPON ANY S10PPAGE OF WORK ON THIS <br /> Phone.259�8910 PROJECT OVER 90 DAYS DURATION. <br />