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Date� '� <br /> Pu�IK Wo�xs Perm�t• <br /> Application For eiap Dep�.+ .���,���J <br /> PUBLIC WORKS PERMIT �������W�«aF�a <br /> Toial Fee S <br /> Lr55 Appl Fee oa�d $ <br /> Print or Type Only o��a���o�� s_ <br /> ��P.,,.��,�-Ku-fG IFe.c Snnul 3/0 3 -stin,� ff�� EvP�pf� 9�f Zn i 3 sS 3 e2� <br /> OvTer Mailing Address Gty Zip Phone <br /> 4� ��LlLI(1P� �,Qk.D—;1.Q F�l�iitti �— iP/ �{- asa U31 <br /> Apphcant Madmg Address Ctlp Zip Phone <br /> Describe Proposed Work �.-t��Gc� n,c�r� �T�.lan � Of/P/' �Q/p.� � <br /> —7 <br /> Project Address�il known) 3�n 3 i1 ��i'�i�Y _ � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note Ihe following as apphcable: � <br /> • Property Lines • Cemerline of stree� � <br /> • Outline and dir�ensiens ol all existing and • Indicate North <br /> proposed shu„iwes on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls 1or inspection shall be made 24 hrs.in advance-phone 2b9•$$�0. � <br /> 2.All work shatl be pedormed in accordance with ihis permit and current City of Everett Design and Construction <br /> StanAards and Specifications. <br /> 3.Cali Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��r ,����� � <br /> ��/2— �-�8 ♦~A <br /> V/ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDI1lONS <br /> The undersigned owner/applicant hereby agrees tc hold and save harm- <br /> less ihe Cily ol EvereU trom any and all Claims for damages. cos!s. <br /> expenses, or causes of action tha! may arise because ol installation <br /> and maintenance of ihe improvemenl or other ri�hFo!�way use hereto <br /> appiied lor and lur�her agrees to remove same upon noLce irom the <br /> Approved lor Conslruction Date City and to replace puUhc pwnerty dama�ed thereby <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signatuie of Applicant pate <br /> everet� PUBLIC WORKSDEPARTMENT WORK AUTHORI2[D BY THIS PEFMIT �1U5T BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERM1IIT IS ISSUED AND THEriEAFTER IS 70 <br /> Evcrett,WA98201 BE DILIGENiLY PURSUHD TO COMPLETION. 7HIS PEPMIT MAV oF <br /> Phona 259�8810 CANCELLED BY THE CITY UPON ANV STOPPAG[OF WORK ON 7H15 <br /> PFOJ[CT OVER 90 DAYS DURATION. <br />