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Date PuEIm Wo�As Permn• — <br /> Bl�p Deo� � — <br /> Applicatio� For <br /> PUBLIC WORKS PERMIT Puoio�FaeF<e s — <br /> lesa ApO�Fee PaiE S <br /> Balence0ue s <br /> Print or Type Only <br /> �F�,�L.,O 1 5��.11"��2 �7z7 - 7� sct� /�v�'/� r�v �z�� � .�sz—��3z <br /> Ovmei Meihng ddress Cdy Zip Phone <br /> C' _ <br /> r <br /> Ap licant Mailing Address City Zip Phone <br /> .� i� <br /> Describe�ProJosed Work <br /> � � i � � G✓ �. �� �� - �12. _ r � <br /> � , ` <br /> � <br /> i � <br /> / i � <br /> p-,/' 2 �:,�r C �;�;t�' Y.��c�'-C - <br /> Pro�ect Address(f known) I, �—v---�-------- <br /> Atlach lour(4)copies ol plans lor proposed work- Draw to scale and note the following as applicable: � <br /> • Properry Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate �orth <br /> proposed slrucWres on ihe lol • Show any proposed gratling changes <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRI1E BELOW THIS LINE O <br /> �ERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259$81 5. � <br /> 2. All work shall be performed in accortlance with this permit and current City ol Everr.tt Design ac3 Construction � <br /> Standards and Specifications. r: <br /> 3. Call �ocation Underground Service 48 hrs. belore you dig.TOLL FAEE NUMBER 1•S00•424-5555. � f; <br /> ttl <br /> �ef '�� O <br /> � � <br /> �,�r n � � � <br /> Qb��" c� N `� � <br /> .�. � � C c ` <br /> �� P 5 �� �,,,,.,�� � � <br /> � <br /> r `�G�-�° �, � �r a � � <br /> 3' � � ` <br /> � : <br /> � � <br /> AGKNOWLEDGEMENT OF COIJDITIONS � � <br /> c <br /> The undersigned owner/applicant hereb;�agrees to hold and save harm� � <br /> — Iess the Gity o� Everett irom any and all claims lor damages, cosls, O � <br /> r.xpenses. or causes ol action that may arise because ot installation y ��� <br /> and maintenance of Ihe improv-ment or othr,r rigM�obway use hereto � <br /> applied for and luriher agrzes to remove same upon nolice �rom the � <br /> ApProved lor Construction �a�e City and to replace public proPerry damaged thereby. <br /> � r <br /> f' <br /> FINAL INSPECTION �a�e Date <br /> Appwved as Constructed Signature o�ApPlicant , <br /> WORK AUTHOFIZED BY THIS PERMIT MUST Bt STARTED WiTHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �i:� <br /> � 3200 Cedar Slreet BE DILIGENTLV PURSUED ?O COMPLETION.THIS PERMIT MAY BE <br /> Everell.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATION. <br />