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Date.�C.�(� �+ Pubhc Wmks Parmit s �v � ��� <br /> � � eiaa oeni., �i tQ" i�l� <br /> Application For <br /> PUBLIC WORKS PERMIT PubhcWoikSFee <br /> Tolal Fee $ <br /> Los.Ap01.Fee Paid $ <br /> Print or Type Only ea����eo�� S 21�� <br /> aD6er� Frro-s oZ(�oS iPQ—I�1LJ �- .�[��tr�o �1�0 an 7�� -C 7a3 <br /> Owner Mailing Address Ci y Zip Phone I <br /> M �Vw I <br /> Applicant Mailing Address City Zip Phone I <br /> Describe Proposed Wor1; �IQ(�3_rP �D�!`4 Md {tAdeA- ('����,�y� � b- /�P�(�1C.. �'� <br /> cP��F�I (mf�y�� -- - � <br /> �� ; <br /> p (� ; <br /> Project Address(if known) _ �S�/— 2—'�� vf � � <br /> Attach four(4) copies o(plan, (or proposed work- Draw to scale and note the following as applicable: � ' <br /> • Property Lines • Centerline of street � 'j <br /> • Outline and dime isions of all existin�and • Indicate Norih � <br /> � proposed structur�s onthelot w Show any proposed grading changes <br /> � • Existing and proposed utilities • Show measuremenis � I <br /> . DO NOT WRITE BELOW THIS LINE O � <br /> � PERMITCONDITIOPS I <br /> 1.All calls for inspecf��on shall be made 24 hrs.in advance•phone 259•8810. � � <br /> 2.All work shall be performed in accordance with this permit and cu«ent Ciry ot Everett Design and Construction I <br /> Slandards and Specifications. <br /> 3.Call Location Unde rground Service 48 hrs.betore you dig.TOLL FREE NUMBER S•800•424-5555. � � <br /> I <br /> O , <br /> � II <br /> ) �°� '3� � � I <br /> � °�' '�►"�`" p�, I <br /> ACKNOW�EDGEMENT OF CONDITIONS <br /> The undersigned owner/applican�hereby agrees to hold and save harm- <br /> '—� less the City of Everell irom any and all claims for damages, costs, <br /> � expenses, or causes ol ac�ion ihal may arise because of installation <br /> � and mainlenance of Ihe improvement or other right-of-way use hereto <br /> U �a applied �or and twther agrees lo remove same upon notice from ihe <br /> Approved for Consiry Date City and to replace public properly damaged thereby. <br /> / / � ,y <br /> �' 2�^� �/ / lU <br /> FINAL SPE TION Date ( � r, l /��U <br /> Approved as Consiructed Signature of Applican. Date <br /> evere[t PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS CURATION. <br /> . I <br /> I <br /> i <br /> � <br />