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__ _ � <br /> �: ' � <br /> ; <br /> i'; i <br />� , <br />� <br /> a= <br /> c: <br />�'°� <br /> I <br /> I <br /> ; <br /> Date�-O'�I a���i��w�,wsa�,m�,. ��%' C'� I <br /> � Q. ' <br /> ApPlicatiCn For s��n� Deai . � a��l}— <br /> P�JBLIC WORKS PERMIT v������W���sF�� -------- <br /> ro�xi Fce S _ <br /> Less ApPI.Fee Pam $ ._ <br /> /� 7 <br /> 6alance�ue $�('C�C � <br /> Print or Type Only � <br /> � � ` � �Q.�L �I,� �0�7�-- li <br /> b I <br /> wner Mailin9 Adtlress City Zip Phone I <br /> T���i ����—��QC�7 =���ll?� <br /> Applicant Mailing Address City j� Zip Phone I <br /> Describa Proposed Work _S�f!�� C J�I ��O.Z���, li <br /> � � — W I <br /> Proiect Address(it known� ���n��— J�-- �F�.c, � ' <br /> Attach four(4) copies ol plans lor proposed wor6- Draw to scale and note the tollowing as appl;�able: s� li <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions ol all existing and • Indicate Norih <br /> proposed siruClures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed u�ilities • Show measurements � <br /> DO NOT WRITE 8E�_OW THIS LINE <br /> PEFMIT CONDITIONS O <br />. 1.All calls for inspection shall be made 24 hr-.in ativance-pnone 259-8810. � <br /> 2.All work shall be performed in accordance with ihis permit �nd current City of Evoiett Design and Construction ; <br /> Standards and Specitications. <br /> 3.Call Location Under�round Service 48 hrs.before you diy.TOLL FREE NUMBER 1•500-424-5555. a i <br /> LI <br /> � <br /> � <br /> � <br /> � <br /> a � <br /> , <br /> � <br /> � ACKNOWLEDGEMENT OF CONDITIONS � <br /> �� The undersigned ownedapphcant hereby agrees to hold and save I�arnr <br /> � less the Ci�y of Everett from any and all claims for damages. costs. ���. <br /> � . expenses. or causes ol action Ihat may arise because of inslallation <br /> �� / � - _Z � ;� _��_ and maintenance ol ihe iinprovemeni or o�her right-of-�may use hereto �� <br /> � � /�y� '�,y=y=��.� `� ' applied for and �urihci a9rues to remove same upon nutice Irom the <br /> Appreved for Consirucyo � ate City and to rephace pu6lic property damaged thereby. <br /> %'.. ,f-/-�j� � c..__ . r'lr'S <br /> FINALINSPECTION Dale ��-�_� _�..�_��_(�__(_ <br /> Approved as Constructed S�na aie b+ Applicant DE�te <br /> everett PUBLIC\YORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST B[ STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> [verett,WA98201 BE DILIGENTLY PURSUED TO COMPLETI(JN. THIS PERMIT A9AY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />