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' --- .. _ _._ .._ <br /> --, , .. <br /> s .._.._._...,--- <br /> /�� -� i7- .37 <br /> Date,—�.���� Pubuc Wo�1�Peme� 9 —�9� _ <br /> AppliCation For e�no ueo�.• ?�'� �;� � __ <br /> PUBLIC W�DRKS PERMIT P�����W�«=��a --- — <br /> ,a�r�F�� s — <br /> 1e55 Rppl Fee PaiU �— <br /> Print or Type Only Ba�a��eo�� S z��� _ <br /> �� � <br /> � ��� �').��. �l'I � '��% �f_' I'E�'��li"� Yll�'7 �����`� /�� �7/���1' <br /> wner ^� Mailing Address ' Gty Zip P one <br /> Applicant Mailing htldress Ci�y Lp Phone <br /> � `� / <br /> Cescnbe Proposed Work •���._ l ,1 ,_ _ <br /> ProieUAddresslifknown! U��B " mE /D/AN q✓� � <br /> Attach four 14)copies ol plans br Groposed work- Draw to scale and note the lol�owing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dlmensions ol all exisling and • Ineicate North <br /> proposed structures on the lot • Show any pioposed grading changes <br /> • Exisfing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2 All work shall be pertormed in accordance with this permi!and current City of Everett Design and Construction <br /> Standarde and Specifications. <br /> 3.Call Location Underground Service 48 hrs.bebre you di,.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ^� ACKNOWLEDGEMENT OF CONUITIONS <br /> i � <br /> ) The undersigned owner/applicant hereby agrces to hold ano save harm� <br /> less ihe City ol Evere�t Irom any and all daims lor damages, costs. <br /> ' /2�/� �J expenses, or causes ol action ihat may arise because ol installation <br /> ,Y _ fs �/3�'/p� and maintenance ot ihe improvement or other nght�ol-way use hereto <br /> Z' ���� � � applied for and lurther agrees to remove samP upon notice Irom ihe <br /> Approvetl lor Construct� / Dale City and to replace public pro erty damaged ihereby. <br /> �� l�l��r�! ��- G� d's- �� t // <br /> fINAL INSPECTION Date " / _ <br /> Approved as Cnnsiructed Signa we ol ApplicaM Date <br /> rveren PUBLICWORKSOEPHRTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 32�OCedarStreel 180 DAYS OF D;TE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,1VA99201 BE DILIG[WTLY PURSUED i0 COMPLETION. THIS PERAiIT MAV BE <br /> Phone:259-8510 CANCELLED �V THE CITV UPON ANV STOPPAGE OF WOHK ON THIS <br /> PROJECT OV[F 3U DAYS DURATION. <br />