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�,--� <br /> � <br /> I :t <br /> � <br /> Date ? � ,�s <br /> , Pu�lic Wo�ks Pmmpil p• <br /> Application For oia�.o�o�.+ —C]n._�-��/R' <br /> i <br /> PU�LIG WORKS PERMI�' ����,�Wo�ksF« — <br /> T����F�.� s <br /> Less Appl.Fee Paid A . <br /> Print or Type Only e������o�� s � <br /> ! -. <br /> _Il�rd-171ir �onmp .S„�/,v,:�- i�,/,:�, f��" C� Cv ��v��f 9���10 �vS��s�6L_ ' <br /> Owner � Mailmg Address City Zip Phone <br /> lLrxn /'cr,��a,, '� �r�r�` !.(�'�('�t � � �� � �%���� .�.�s.;� _lii� / <br /> Applicant Mailing qdAress �ity Zip �`'^'�o�� � <br /> De•scribe Proposed V✓ork �� <br /> f�L f� / � <br /> Project Address�il known) �.��`, — �n I T _ � <br /> Atlach four(4) cepies of plans for proposed work� Draw to scale and note the foilowing as appiicable: � <br /> 9 Property Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and o Indicale North <br /> propesed structures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utiliGes A Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall he made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and r,urrent City of Everett Design and Construction <br /> �tandards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � ' <br /> /r/Y� ��,�.� � � O <br /> �.f,u/ � <br /> �. - <br /> 7-�G _�-�� � <br /> � <br /> � <br /> ACIWOWLLD(;F_MENT OF CONDITIONS <br /> _ _ The undeislgned o�.vneriapplicant nereby agrees to hold and save h2rnr <br /> I less ihe Cily ol Everelt Irom any and all claims for damages, cosis, <br /> expenses, or causes ol aclion that rnay arise because of insfallation <br /> and maintenance of Ihe improvement or other ri9ht-of-way use hereto <br /> Approved lor Consiruction pa1e ap�. �ed for and luriher ac�rees to remove same upon noticu Irom thc <br /> City and to replace public properly damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�ructed Signature ol Applicant p�j��, <br /> <�veretl PUBLICWORKSDEPARTMENT WORK PUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarS�reet 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere�L WA 3Fi201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PFRMIT P:1AY BE <br /> Phon¢25�J-II�iO CANCELLED BY THE CITY UPON ANY STOPf�1GL O°N;ORK pN TI-IIS <br /> PROJECT OV[R 90 DAYS DURATION. <br />