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/ � <br /> o8ce f�-.:S �,,� C��.:�<..� 9-ia -s <br /> P�blic Worka Permn� _f�i?�3� <br /> Application For eieo.onw.• <br /> PUBLIC WORKS PERMIT ���kWo�.F» <br /> Tot�i Fsa = <br /> Le��APoI Fx P�iO s� <br /> Print or Type Only eaience oue i l/G � <br /> .l,eLP S � 0�� aa�• E. Uf�sr�z�.�� RD cA��d �s�. W,�.9g��1 3 87--19ii <br /> Owner Meiling Add�ess Cit � <br /> 1 Z�P Phone <br /> t79� <br /> Applicant MailingAddress City 2ip rhone <br /> Describe Proposed Work Si�P/l��. _ A��/ S �r�{, � � <br /> /'Yt� ✓L <br /> �.,-,s,.�.e�.._. .r.�o��.7�� c,lvra� .� <br /> ; <br /> Project Address(if kno�.vn) 3 � � S _ � <br /> Attach lour(4)copies ol plans for proposed work• Draw to scale antl note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outiine and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hra in advance•phone 259-$87 5. <br /> 2. All work shall be perlormed in ar.cordance with this permit and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3. Cell Locetion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBEN 1•800-424•$555. <br /> �. ��E� Q�je�/Yi'..o ��/CGf7S � <br /> / O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEUGEMENT OF CONDITIONS <br /> The undersigned owne�/applicant hereby agrees to hold and save harm- <br /> less ihe City of Everett �rom any and all claims for demages, costs <br /> ezpenses, or causes ol action that mny arise because ot installation <br /> �� _ �.. � and maintenence of the improvement or other right-of-way use hereto <br /> Ap o ed for Const lon , — applied for and fuhher egrees lo remove same upon notice 1rom the <br /> Date City and to replace public property damaged thereby. <br /> � ��� � � <br /> FINAL IN PEC710N Date <br /> App�oved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORh AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8H15 CANCELLED 8V THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. �.�. <br />