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Date �/, zlp��' aummvm,FSFn,nui , _ j <br /> � �F�/Zo'�/X I <br /> Application For Bleg.Dep�.• , <br /> PUBLIC WORKS PERMIT' P°°��°W°�kzFe� ' <br /> Tolal Fee S <br /> Less Appl Fee Pad S <br /> Print or Type Only 8,���=�o�� S I <br /> r�(� a�, ���5�� .�r z ��� -3 � rit s�t ��p;p� w� ���� , <br /> � Owne A Mailing Address Cily Zip Phone i <br /> �--q�� � C�ilP� R�,r � (� nf �Or,7 1�7j3cx N�p i <br /> A licant �ailing Addre s City Lp Phone <br /> I <br /> Describe Proaosed Woik ��L� n�������lc���./ � �i�'n��11).CQ���� '�` � - I II <br /> ��> rn�� � � <br /> i <br /> /� � C � i <br /> Projecl Address(if known) � ��1�` � 7 1�� I <br /> Attach lour(4) copies ol plans for proposed work- Draw to scale and nole the following as dpplicable: � . <br /> • Property Lines O Centerline ol street ♦A <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on ihe lot • Show any proposed gradin� changes � <br /> ! ExiSting and proposed u�ilities • Show measurements rp <br /> r� IDO NOT WRITE BELOW THIS LINE � � <br /> PERMIT CONDITIONS <br /> 7.All calis For inspeclion shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construclion <br /> S�andards and Specifications. <br /> 3.Call Location Underground Service 46 hrs.before you di9.TOLL FREE NUMBEfl 1-800•424•5555. � <br /> /���i�G CG�U-�•i3 r>_L';�.�t.t,-! i71v.��/��p.L'��.�.��� <:)%;� � <br /> , � J-�.J-�9 �— <br /> Vd <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF GONDITIONS ' <br /> The undersiqned ov+ner/applicanl hereby agrees to hold and save harm- <br /> less the City ol Everetl irom any and all claims for damages, cosls. <br /> expenses, or causes of ac�ion ih�t may arise because of installation <br /> and mainlenance of ihe improvement or other right-ot-way use hereto <br /> applied for and further agrees to remove same upon notice from �he <br /> Approved lor Consiruction ���e Cily and to replace public property damaged thereby. <br /> FINAL INSPECTION Date � <br /> Approved as Constructed Signature nl Applicant Date � <br /> everett PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO , <br /> � 3200CedarStreet BE DILIGENTLY PUNSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Eaeretl,WA 98201 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS ! <br /> Pt�nne:259-8810 PROJECT OVER 90 DAYS DURATION. , <br /> � —- -� <br />