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^//�'�3 PUCIic Wo�ka Permit• �� ` �� <br /> Date__Fi� � �// /G� <br /> BIaB�Deo���— <br /> qpplication For <br /> PUBLIC WORKS PERMIT PubTo�FeaFee s�� <br /> ro <br /> Less A00�fea PaIE g <br /> Bela�ceDua s �J <br /> Print or Type Only ��335�/ <br /> 1626 w ��Cv�2 tk Ro .e,�.��}-f 982��� � 337 —s'uc� <br /> �UIC IVe� `� �i�Y Z�P phone <br /> aW�ef Mailing Address <br /> �, � skY L.x�S•�'. .�� C3: 338 -� �AC v� _ 9dLrl �793-c:zdr <br /> AppliCant <br /> Mailing Address City Zip Phone <br /> Describe Proposed Work �' �S ` ��'���0� �~ ��� ��M� - <br /> W <br /> Pro�ect Address(if known) SII Gf �aKt � H <br /> �� <br /> Attach four(4)copies of plans lor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all ezisling and • Indicale North <br /> proposed siruclures on�he lot • Show any propo5ed gradin9 changes <br /> • E�.isting and proposed utilities • Show measurements M <br /> W <br /> DO �'OT WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS � <br /> 7. All czlls for inspection shall be made 24 hrs. in advance-phone Z59•881 5. <br /> 2. All work shall be pertormed in accordance with this permit and current City ot Everetl Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> ? � � <br /> z . ��°` � <br /> N <br /> O <br /> �. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby aSrees to hold and save harm- <br /> less ihe Cily of Everett Irom any and all claims for damages, costs, <br /> eaoenses, or causes ot aclion ihat may arise because of installation <br /> �_�_�3 and maintenance of the improvement or olher right•o4way use hereto <br /> applied lor and luhher agrees lo remove saroe upon notice irom the <br /> roveA tor Construclion �a1e City and to replace public property damaged �hereby. <br /> . � <br /> Q / � <br /> FINA � NSPE ION � e Date <br /> Approved as ConstructeJ <br /> Signature ot Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHi <br /> everett PUBLIC N'ORKS DEPART ENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 'S 70 <br /> � 3200 Cedar S�reet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br /> Phone:259�8815 PROJECT OVER 90 DAl'S DURATION. <br /> I <br />