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__ �� <br /> . � � <br /> • � �v��6_�L�S a�en�won.vr.��u. <br /> ,j y _ Application For eiaa.o�c�..— <br /> '~ PUBLfC WORKS PERMIT Pu�ia�FeeFea f ��—�� <br /> Less AO��Fee Psip S <br /> P�int �r Type Only BaienceDue s _ <br /> L�d�,d� NC'�l� �C�� ,(= IJ�61V,U S yb 07G 7µs .s .�aq <br /> Owner Mailing Address City Zin Phone <br /> Sac Fa� � � <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �� vN � T � —f��c+.L�en"�R <br /> Pro�eet Addreas�if known) � O �—��...�je� �� � � ( �, �, � <br /> � <br /> Attech lour(4)cepies of plans for proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> • Prope�ty Lines • Centerline ol sireet � . � <br /> • Outline and dimensions of all e�isting and • Indicate NoAh <br /> propoaed siructures on ihe lot • Show any proposed grading changes <br /> • Exicting and proposed utilities • Show measuroments � <br /> DO NOT WRITE BELOW THIS LINE � � O <br /> PERMITCONDITIONS ���� �. <br /> t. All ca�ls for inspection shall be made 24 hrs.in advance-phone 259•881$.� . � ' � <br /> 2. All work ehall be performed in acwrdance with this permit and current City of Cveretl Design and Consiruction <br /> S�ancfer.ls and Specificationa. <br /> 3. Cell Location Underground Service 48 hrs. betore you dig.TOLL FREE NU�IBER�1•800•424•5555. � <br /> .� P..�. �,� �a,�P� �-�-��.��` ;_ O <br /> ,, <br /> �:���� I-- <br /> �.�. N <br /> O <br /> �, a <br /> ACKNOWLEDGENENT OF CONDITIGNS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> leos �he Ciry of Everett frum any and all claims for damages, costs, <br /> � expenses, or causes ot aclion ihat may arise because of installation <br /> 9/�.�� and maintenance o( the improvement or other riqht-oFway use hereto <br /> applied for and further agrees to remove same upon notice irom the <br /> ApP�'ed lo( 0 1 ugle n Date Cily and to replace public property damaged thereby. <br /> / p <br /> l� l '�/ - !� � <br /> F�NAL I ECT ON Ua e � .�7 .6 <br /> Approved as Constructe Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPAfiTMENT WORK AUTHORIZED BV THIS ERMIT MUST B TARTED WITHIN <br /> � 3200 Cedar Street 180 DAVS OF DATE PERMI IS ISSUED AND TH REAFTER IS TO <br /> EveretL WA 99201 BE DILIGENTLV PURSUED YO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-88 t 5 CANC[LLED BY THE C�TV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT O\'[R 90 DAYS DURATIOI��. <br />