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�� � <br /> O�x <br /> ry5qy <br /> HzN <br /> K n <br /> H � <br /> �� <br /> � f�nH Date�� �� � � �„�,�,��vo•.,�,., <br /> v �'j � <br /> H �+ e�na o�o� • �__����-1_lJ_ - <br /> � O ^3 Appbcalicn Fa --- — <br /> oHd PUBLIC WORKS PER1411T <br /> PaLI¢WO�AS Fee <br /> io�alfpp 5-. <br /> H � g lrzs4nnl FerPa�it 5 -- <br /> �V (] <br /> [�.11:ln'�.n�:�. 5 <br /> S y� Prinl or Type Only ---- <br /> t� <br /> �yHH <br /> O y�"� 'r��� <br /> n�y� wner MaJin�Atltlro55 ���1' LT Phone <br /> � HV�i <br /> y � y Applicant Maihng Adtlress City Zip Phone <br /> DescriAc Proposed lVork _ 1 _.J —. ` � [ ^ ������'� ( J�-- <br /> Pro�ect Adtlress 1�1 knownl ��I�ol– ^ '�� ^ � � <br /> p��a�h luUr 141 COpiCS ol plans 10�ptOpOSCd w0�k- Draw�O SCaIC.lnA nole IhC�OIIOWing ls dpphCnblP. � <br /> � Property Lines • Cenlerhne of street /A <br /> • Outhne and tlimensions of all exishng antl • InAicale Norlh V� <br /> proposed sirucfures on Ihe loi • ShoH�any pruposed grading chanyes <br /> • EzisLng and pwnosed ulihties • Show measurements � <br /> � ' DO NOT WRITE BELOW TFIIS LINE <br /> '�' PERMIT CONDITIONS O <br /> '�' 1.All calls br inspection shall be inade 24 hrs.in advance•phone 259•881 O. � <br /> 2.Ail work shall be pedormed in aCGordance wilh this permit and cutrent Cily ol Everetl Design and Conslmction <br /> Standards and Specificalions. <br /> '�' 3.Call Localion Underground Service 48 hrs.6efore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> i j �� �( C , 0 <br /> � � H <br /> - <br /> - /i>>, �..r- <br /> , �; <br /> 1_� `� ' �'� � <br /> �- O <br /> _� a <br /> ►-� <br /> O�' ACKNOWLEDG[hiENTOFCONDITIONS <br /> - The undersi9ned owner/applicanl he�eby agrees to hold antl save harm� <br /> less Ihe City ol EverMl Irom any antl all claims for damages, costs. <br /> eapenses, or Causes of action Ihat may ari5e UecauSe ol inslallalion <br /> and maintenance ol the improvemenl or other ngh4ohway use hereto <br /> apphed lor and furihe� ayrees to remove same upon natrce Irom Ihe <br /> Approvetl lor Consiruction Oale City and to replace pul�lic n�of•���Y damaged thereUy. <br /> FINAL INSPECTION ���e <br /> Approved as Conslructed Signatwe ol AnPlicant ����" <br /> 6S'ORK AUTHORIZED 9Y THIS P[RMIT M11UST BE STARTED bVITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAVS Of DATE PERMIT IS ISSUED AND THLREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENiLY PURSUED TO COMPLETION, THIS PERM1IIT M11AY BE <br /> Everett.WA99201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON iHIS <br /> Phone'.25�3�8810 PROJ[CT OVER 90 DAYS�URATION. <br />