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� <br /> f �_�Da'e�� v�o����•�o,k�Pe,m��. <br /> Application For eie9 oen�.• ' <br /> PUBt�IC WORKS PEi�IVfIT ��"To,;;F��F�° S <br /> Less�OPI.Fee PaN S ' <br /> Print or Type Only e��,���o�e s _ j <br /> n�rlt�.� Tk>(�+fh n�'�� 'i�'�> `��>�/. ��� !`,I;� i �1`�. c�:'�:,�� �1`�,�n:'� ,-_��=�.�-� � ����, <br /> Owner Mailinq t,ddress Qly ?�� Phonq <br /> ������ <br /> Applicant M�Iling Address C�ty 7_ip Phone <br /> Describe Proposed Work ���/•_ J <br /> Proiect Adtlress(if known) �� �� �l ) �, �� � <br /> Aitach four(4) copies ol plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol streel /p <br /> • Outline and dimensions ol all existing and • Indicafe Norih V� <br /> pruposed structures on ihe lot • Show any proposed gradinc� changes <br /> • Existinc� and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS o <br /> 1.All calls for inspection shall be made 24 hrs.in advTnce-phone 259•8810. � <br /> 2.All work shall be perlormed in accordance with this permit and cu«ent City ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call�ocation Underground Service 48 hrs.6efore you dig.TOLI FREE NUMBER 1•800•424-5555. � <br /> /L�G�/ '1_l,'�tJ/�✓� �ji c�' � <br /> � /" /'.i <br /> � <br /> � <br /> � <br /> � <br /> ACKNONAEDGEMENT OF CONDITIONS <br /> ihe undeisi�pied owner/applicant hereUy aflrees to hold and savc harnr <br /> -- Icss ihe Gty of Eveiett from any anA all claims lor damages, cosls. <br /> expenses, or causes of action Iha( may arise because ol installation <br /> �md mtintenance of �he improvement or olher ri�ht-of-way use heretn <br /> — :�opiied lor and hulher agiecs lo remove s�me upon notire Irom Ihe <br /> APP�oved (or ConsVudion Da�e Qry ����d Io replaa� puhhc prop�,rty d.imagcd iheraby. <br /> FINAL INSPECTION Date _____ <br /> Approved as ConsVucted Signa�ure ol npplican� p��e <br /> everett PUBLICWORKSDEPARTMENT WORK AUTIiORIZ[D Bl' THIS PERMIT MUST BE STARTED l"✓ITHIPI <br /> � 37.00CedarStrect 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY E3E <br /> Evere�t,WA 9820' CANCELLED BY THE CITY UPON�NY STOPPAGE OF WORK ON THIS <br /> Phone 259-0970 I PROJECT OVER 90 DAYS DURATION. <br />