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� �. <br /> Date�Q� PUDirWorF!.Permitp� �_C���� <br /> 6i�9.De�t• _!�_���6�" <br /> Application For <br /> PUBLIC WORKS PERMIT "°°'"`'"°"S0e -- <br /> r�,�,�F�„ 5 <br /> LessApPl FaePaiO � O <br /> �ulxncc Due s �o-n <br /> Print or Typt Only <br /> �_, - do�t N t�t„ seotf(e. 9s�as Saa -���3 <br /> — � ef Mailin9 Address Ciry Zip Phone <br /> Applicant Mailin9 Address Gily 7ip Phone <br /> Descrlhe P.oposed Work Moy.'�..31�tulA---- - <br /> - - W <br /> Proiect Address(il known) `�� G ' �������� � <br /> Attach four(4)copies ol plans for proposed work• Dra�v to scale and note the fo!lowing as applicable: � <br /> � Property Lines • Centerline of street <br /> � Outline and dimensions of all ezisting and • Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show measurements M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE <br /> PERMIT CC VDI�iIONS O <br /> 1.All calls tor insGection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shell be pedormed in accordance with this permit and currrnt Ciry of Everett Design aad Construction <br /> I Stenda�ds and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. � <br />� <br /> 1 O� <br /> I <br /> 1 �� � <br /> � <br /> �• 0 I <br /> a <br /> ACK�OWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to liold and save harm- <br /> � less the City of Everett irom any and all claims for damages, costs. <br /> / expenses, or Causes Of aCtion Ihat may arise beCause ol inStallalion <br /> L n�y/�� !�J 7//�/�p and maintenance of thc improvement or olher right-ol-way use herelo <br /> f�'7 �l / L_ applie.d lor and Wrther agrees to remove same upon nolice Irom the <br /> Approved �r Conslructio � Date City and to replace public property damaged thereby. <br /> ��..a-�'�� � ��Q .%� f' '� � ,� X�r �b <br /> FI�! AL � ECT - " �/ - ' Date r �� ��O '0 7 <br /> Approved as Constructed " Slgnature ol AppBcant Date <br /> �� WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIGWORKSDEPARTMENT 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTL"R �S TO <br /> � 3200CedarStreet BE DI�IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 9820� CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJ[CT OVER 90 DAYS DURATION. <br /> I <br /> � <br />