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✓ <br /> Date�a�a�r TO POSTING i?� �� POO�mWo�hs� �e- 2�� <br /> AppliCe�ion For eiao Deoi • .���7� <br /> PUBLIC WORKS PERMIT �y11To�Fee��� s <br /> Less�Op�Fee Peitl S <br /> PrintorTypeOnly ee�.��eo,e f 2��� <br /> ll1arer.,��ro�n��,'ns 5C3/2 Rwck�. �¢. �vereh�- 339'—/��/ <br /> Owner �� Mailing Address Cily Zip Phone <br /> �,�i(��a.s �- � pv � x �c�I �lv -��ev�rL 33 y,op�s <br /> Npplicant Mailing Atldress City Zip Phone <br /> DescribeProposedWork 1�cLV S�y�fy�l��y �ft�rAl`/ p�1 �. <br /> � <br /> P�oiec�AdAress(il know�) �J�S — �-Qy>�� �- � <br /> � <br /> Altach Ic ir(4)copies ol plans for proposed work- Draw to scale and note the following as applicahle: � <br /> • Property Lines • Centerline ol streel � <br /> • Outline and dimensions ol all existing and • Indicate Norih <br /> proposed stmctures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All cells for inapection shell be made 24 hrs.i�advance•phone 259•8870. � <br /> 2.All work shell be paAormed in accordance with this permit and current City ol Everett Design and Construction <br /> Stenderds and Specifications. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> /� ACKNOWLEDGEMENT OF CONDITIONS <br /> Y/ The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less lhe City ot Everett from any and all claims lor damages. costs. <br /> /J /��7 ezpenses, or causes of action thal may arise because of instatiation <br /> (� /7i __�.vy, 7�O� and maintenance of Ihe improvement or other righ4of�way use hereto <br /> � �����L� ��� � applied for and fur�her agrees to remove same upon notice Irom tM1e <br /> ApF�oved tor Constru n Date Ciry and to replace public property damaged thereby. <br /> / ��--�T ' <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signatuie of Applicant Date <br /> everett PUBLIC WORKS OEPARTMENT WORK AUTHORIZED BY THIS P MIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY �E <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />