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. <br /> ,�: >j <br /> Date Puni¢Wwts Pnrm � ���`/�G <br /> Application For bin�.oeoi.. ��1`-f-1�_ <br /> PUBLIC WORKS PERMIT PUbio�TFeeFee a - -- <br /> Less Apol Fax aa�a S <br /> —� <br /> Print or Type Only DalancrDuc s =-n— _ <br /> . �'. �C�� � �Gt�S��S Iy�[`� /�,�,� 1 �i Irn�' �'�l i J<� ��9�-q�`� <br /> Owner Mailing Atldress City Zip Phone <br /> _ ._l-���-Y .�1 <br /> Applicant Mailing Address City Zip Phone <br /> Descrlbe Proposed Work � JI—i� �� <br /> Proiecl AdAress(il known� _��/ 3Z — � AUF_ /.r JL L� <br /> Atlach four(4) copies Of plans for proposed work� Draw to scale antl note the following as applicable: — <br /> • Properly Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on Ihe lo� • Shnw any proposed grading changes <br /> • Existing and proposed utilities • Show msasurements � <br /> DO NOT WpITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current City of Everett Design and Construction <br /> � Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.be!ore y�u dig.TOLL FREE NUMBER 1•SOO•�32O-S5S$. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> rlc, ACKNOWLEDGEMENT OF CONDITIONS <br /> tx The undersigned owner/applicaM hereby agrees to hold and save harm� <br /> — less the City of Everett irom any and all claims tor damages, costs, <br /> expenses, or causes ol adion that may arise 6ecause ol installation <br /> G.� -% 'c�'�� �–�� iCf and nia�ntenance ot the improvement or other right-o4way use hereto <br /> �� / ///� �� applied lor and further agrees lo remove same upon notice f�om the <br /> Approved tor Consiruction ���te City and to replace public property damaged thereby. <br /> ��'� F-/—6-� <br /> FINAL INSPECTICN Date <br /> Approved as Consvucted Signature ol Applic2nt Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,VJA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-88i0 CANCELLED BY ThIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />