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oete�9i ---. `� <br /> hElle Wo�ks Parmll• <br /> Applicenon For eiaa.oaoc s _ <br /> PUBLI� WORKS PERMIT PuElicY.'orksFes <br /> Tole�Fee � __ <br /> Lees ApnL Fae Pe10 S <br /> Print or Type Only 9alance0ue s <br /> /� `_, A, �SQ—?�,,`�� <br /> ' �t�,l�r� l� �//1��, l�Q,� �i'�n_ �9 � /�L.N�. �ml�4f1�1��Q �lL7/J /• �4 (�y <br /> , owner �g Addreas City � Z�p pha�e �"—"� <br /> _ ��'il)1^�/' <br /> ' � Rppllcent Mailing Addresa City Zip Phone , <br /> � . Deac�ibe ProPosed Work _ �el�J.(LR�3�o�� �((XCtr��� �f2l'/�f�'L�r.N,C � <br /> / �l <br /> i . <br /> • <br /> �� Prolect Address(if known) — � � <br /> ' �� Attach four(4)copiea of plans tor proposed work• Draw to scale and note the following es applicable: � <br /> i <br /> � i�. � • Property Linea • Centerline of street � <br /> f .� � • Outline and dimensions ot all existing and � Indicate Norih <br /> r � proposed atructures on the lot • Show any propoaed grading changes <br /> ! �;,.. � Eziatlng end proposed utilitles • Show measurements � . <br /> � . DO NOT WRITL BELOW THIS LINE <br /> � PERMITCONDITIONS O <br /> � . 1.All calle tor Inapectlon ahall be made 24 hra in advance•phone 259-8810. � <br /> , , 2.All work ahall be pedormed in accordance with this permit end current City of Everett Deaipn and Construdlon <br /> Standerda end Speciflcatione <br /> 3.Call Location Underpround Service 48 hra before you dig.TOLL FREE NUMBEA 1•800�4245555. � <br /> ;��� � ,�.,�,�,�� O <br /> �''��� I- <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett from any and all claims for dameges, costs, <br /> � ' expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other right•of•way use hereto <br /> applied for and further agrees to remove same upon notice from ihe <br /> Approved for Conslruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conatructed Signature ot Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> II � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE G:LIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-BB70 PROJECT OVER 90 DAYS DURATION. <br /> il <br /> I <br />� <br /> l _ <br />