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i� <br /> . <br /> Date��V PuplicWo�ksPermtl> ��'�3�5 <br /> Appl�ca�ion For emA.oeo��+ _ � <br /> PUBLIC WQRKS PERMIT PwecWorksFee — <br /> To�al Fee $ <br /> less Appl.fez Pai� $� �� <br /> Pfint Of Type Only ea�r��eo�e S� _ ! <br /> I <br /> �A�rrN �����_ �'�1 y �XC�t'��1'��1 ���q Fso� � I <br /> Owner �ailing Add�ess Ciry Zip Phone I �. <br /> ���y3�L <br /> Appiicant Mailin,q Address City Zip Phone . � <br /> ' Describe Proposed Work �...�� 1L— . ____ � <br /> — _. � <br /> Project Address(if known) �/9/9 - �%�q�E�. ._ W j <br /> � i <br /> Attach f�ur(4� copies of plans for proposed work- Draw to scale and note tFe lollowins 3s applicable: r <br /> • Praperty L�nes • Centerline of street � <br /> • Odtline and dimensions of all existing and • Indicate '�ortn � <br /> proposed 5tructures on Ihe lot • Show any {.�roposed gradinc�changes � �. <br /> .: • Existing and proposed utilities • Show measurements � i . <br /> I <br /> : DO NOT�"iRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hre.in advance-phone 259•881 O. � I <br /> 2.All work shall be pedormed in accordance�vith this permit and current City o:Everett Desinn and ConsUvction <br /> . Standards and Specifica'+::�. � <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � I <br /> O <br /> � <br /> � <br /> 0 <br /> a <br /> � i <br /> ACF:NOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner,'applicant hereby agrees to hold and save h�.. �� i <br /> --" less ihe Cily ot Everett irom any and ali claims lor damages, cc�ni�.:. <br /> ) expenses, or ca:�ses of action that may arise because ol install..rion � <br /> � �"+ /�7��0 and meiNenance rn Ihe improvemerl or other right-obway use hereto I <br /> � � appliad for and further agrees to remove same upon notice Iror,�, the , <br /> Approved for Cons uction Datr. City and te replace public properry damaged thereby. �� � <br /> --- __ � .� .� �-���'____ `�,-/3/�� ' <br /> � FI ECTION �ale <br /> A proved as Constructed Signature of Appl cant � Date <br /> everett PUBLICWORKSDEPARTMENT WOHK AU�HORIZED BY THIS PERMIT MUST BE STARTED WITHIN . <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. TFIIS PERMIT MAY BE <br /> Everett,WA98201 CANCELLED BY T�iE CI7Y UPON ANY STOPPAGE OF WORK ON THiS <br /> _J ?hane:259-8810 PROJECT OVER Ri) DAYS DURATION. � <br /> I <br />