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� <br /> i <br />�: ! <br />��``'r <br />� �s i <br /> _ _ "`�-- � <br /> ' PUDLCWortisPer. � J�� <br /> Date�-�� � <br /> –s-- <br /> Uing Da�t� �� �..���'�.. . <br /> Application Por � � <br /> PUBLIC WOF�KS PERMIT FuehcWo,MSFCe — <br /> Total Fee S-- - <br /> Less(�ppi Fne P.IN 5__ <br /> � n�� <br /> .iaia�r.e oue S L:�" _ � <br /> Print or Type Only — , <br /> � �, �� I / / ��I <br /> ��'lrl�I�(.Ilr> �` i.tc;�i�`� ��,11D /�I(� <f�ll/i^C�/� � Yl%� �'--��.� <br />� Owner Mading Address City Zip Phone <br /> _ �_-S�—�� <l`'� �l �.��� �I <br /> Apphcant Mailing Address City Zip Phone I, <br /> Descnbe Proposed Work G�/`= - ` �-�- ' � I I � E � ` � �_ _.._ II'�i <br /> ` � II <br /> Proled Address li� knownl / �C �J J�- •=���� k� � <br /> Attach four(4) copies of plans for proposed work� Draw to scale and ncte the lollowinq as apPlicable: � <br /> • Property Lines • Centerhne ol sireet � <br /> • Outline and dimensions ol all existing and • Indicate Kor�h <br /> proposed sVur.�ures on the lot • Show;my proposed grading chanqes � <br /> • Ezisting and proposed utilities • Show n,�a°uremenis � i <br /> DO NOT WRITF BELOW T'l15 LINE_J � <br /> PERMITCONDITIONS O ��I <br /> 7.All calls fw inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pedormed in accordance witn this permit and current City of Everett Design and Construction � I <br /> Standards and Specificatiuns. <br /> 3.Call Location Undeiground Service 48 hrs.before you din.TOLL FREE NUMBER 1•800•424•5555. � <br /> O , <br /> � <br /> � <br /> \� <br /> LL � <br /> w' <br /> ACKNOWLEDGC-MENT O"r CONDITIONS � I <br /> '�1�� The undersir,ned ownedapplicant hereby agrees to hold and save harnr � <br /> less ihe Ciiy ol Everett trom any and all claims for damages, r.osis, <br /> // expenses, or causes ol action thal may arise because of installa�ion <br /> .�J{ ' � ? j, �� � J: � and maintenance ol lhe improvement or other righbohway use hereto I, <br /> �/�!� �J7r.,f"" applied for and further agrees �o remove same upon notice irom Ihe <br /> Approved lor Consiruction Dale City and to replace publlc property damaged thereby. <br /> �e�� �'-/-�S' /f .--�. � /)� ' <br /> FINAt W PECTION � Date ��– �— 3 '�1-_ � <br /> Approved as Construcled Signatur� o�Applicant dat� �,I <br /> everell PUBLICWORKSDEPARTMENT WORK AVTHORIZED 6Y THIS PERMIT MUST BE STARTED WITHIN i <br /> 780 DAYS OF DATE FERMIT IS ISSUED .4ND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> ft�erer„WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON��HIS <br /> Phonc:259-8810 PRO.IEGT OVER 90 DAYS DURATION. <br /> I <br />