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p� �Date � �L' `'� • ` PUEI�c Woiks Permil� _ <br /> Application For Biaa�Deo�.•_ {�S ��� <br /> PUBLIC WORKS PERMIT PU�TaiaFceFce s <br /> Less ApPt Fee Paid $ <br /> Print or Type Only s��a��ao�o s__ __ <br /> h�i,cr �)/sn� 37�1 - Sl�nri� (� ✓P � ✓r�ef� �Fa� ? 35 .; -�s ', � <br /> Owner N��iling Address Gity Zip phone <br /> Sa �, f_ <br /> Applicant Mailing Address City Zip Phone <br /> r� p J / /� [� <br /> Describe ProPosed Work � r i �(1I C�('�N�i 1� �M � ! �����,c Y f R - �_C iH[l�d i-�,�n � /,i %�J�/Y�P/1 /,� <br /> ✓ <br /> n w <br /> Prolect Address�if known) �� �� � ���'/W q��� � <br /> Attach four(4) copi�es of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Cenledine ol street ♦w <br /> • Outline and dimensions of all existing and • Indica�e North V<<� <br /> proposed structures on Ihe bt • Show 2ny proposetl prading changes <br /> • Existing and proposed ulilities • Show measurements � <br /> DO NOT�VRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. fr:l calls lor inspoction shall be made 24 hrs. in advance- phone 2R9•881 5. � <br /> 2. All�rvork shall be perlormed in accordance with this permit and wrrent City of Everett Design and Construction <br /> Standards and Specilicalions. <br /> 3. Ca.11 Localion Underground Service 4B hrs. before you di�.TOLL FREE NUMBER 1•$00•424-5555. � <br /> /��� /-/-l�'_/iG `%-LY,'��S �'c�i__:i». :— i(��'�'; �,�_; � O <br /> ��=` �Q��/�_�- I— <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/e�pnlicaM hereby agrees to hold and save harm- <br /> — --- less the City ot Everelt Imm any and all claims for damages, costs, <br /> eapenses. or cause�; of aclion that may arise because of installalion <br /> and maintenance o�� the impiovement or othe�right-ohway use hereto <br /> applied lor and twiher agrees to remove :ame upon notice from the <br /> .4pprovetl lor Construction Da�e City and to repla;;e pu�lic prooerty damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Sionature of Applicant Date <br /> ev�rett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE OILIGENTLY PUfiSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 9�201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJ[CT OVER 90 DAYS DURATION. <br />