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�= <br /> Date� � =1�' a�o����worasa m,i. ���cJ — 5� � <br /> Application For eie9.o�pi..� � � <br /> PUBLIC WOFiKS PERnlII d• �uOTolalFaeFev y, / — <br /> Less Appl Fee Paid $ <br /> aamnco oon S <br /> 2U���- <br /> Print or Type Only — <br /> (�1 n / ,� � <br /> ..�-Un.„�, � � r�,-�10 `���i�e�e'���r�`1-I�-1e<)� �/�� ���� <br /> wner Nlailmg Address City � Phone <br /> � �G"�..C <br /> Applicant Meiling Address City Zip Phone <br /> Describe °ropos��d Work ��J�1� <br /> Project Address(if V�.no�rm) � � _ IG l�C��— /; �h/�ic� -SC:'- � <br /> � <br /> Attach four(4)copies of plans for proposed work- D�aw tu scale ano nole the tollowing as appiicable � <br /> e Property Lines D Cen�erline of sireet � <br /> • Outline.:nd dimen5ions of all existing and O Indicatr North <br /> proposed slructures on the lol O Show any proposed grading changes <br /> • Exislin� and proposed utilities O Show muasurements ,J <br /> �� <br /> �� DO NOT WRITE BELON THI�LIar'.�E � <br /> PERMIT(:ONDITIONS <br /> L All call;for inspection shall be n��de 24 hrs. in advance-phone 259-881 5. � <br /> 2. ,411 w. k shall 6e performed in accardanc=with this permit and current City of Everett Dzsiyn and Jonstruction � <br /> St.mdurds and Specilicotions. <br /> 3. Call:.ocation Underground Service 48 hrs. before you dig.TdLL FREE NUMBER 1•800•42�•5555. � <br /> \P" <br /> �p: <br /> y� <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apPlican�hereby agrees to hold ar�tl save harm- <br /> less the City of Everett from any and all claims for damnges, costs, <br /> expensr.s, er causes of action Iha� may arise becausa of installation <br /> ���� ����-��� and maintenance ol the improvemenl or other righi-ohway use hereto <br /> applied tor and further agrees to remove same upon notice Irom the <br /> Approved for ConsL•i. tion ' Da�e City znd to replace public�ro rty damaged ihereby. <br /> �� Z �S � (�� <br /> FINAL INSPECTION Da e � � ��� � '�� �� ��/� � �� � v� <br /> Approved as Constrvcte natwe cf Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORV: AUTHORIZFD BY THIS PERMIT MUS7 B'c STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DA?E PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everett, WA 98201 6E DILIGENTLY PURSUED TO CO�dPLETION. THIS PERMIT IviAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DA'!5 DURATION. <br />