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r <br /> ���e�� Pu�l¢WorksPor � �('��/L/�—,J«�.' <br /> BIEB.DeO� � ��--- - - <br /> Applicalion For <br /> PUBLIC M/ORKS PERLMIT PubTotaFeefee $ ---- <br /> Less Appl.Fee Paia $� <br /> Balancrn..r $ �?�— <br /> Print or Type Only <br /> �� �3.s' � - ��� I <br /> ` � V <br /> wner fAailing Address Gly Zip Phone <br /> Applican� Ma:ling Address City 7ip Fhone <br /> �/�Describe Proposed Work � , — <br /> Project Address(if known) �G��� /�' �'�v'� -rE � <br /> � <br /> A�tach tour(4) copies ot plans for proposed work- Draw to scale and note ihe following as apphcable: �� <br /> • Property Line. w Centerline ol street /A <br /> • Outline and :imensions of all existing and • Indicate Norih �� <br /> proposed sVuctures on ihe lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measuremer�ts � <br /> ��� <br /> DO NOT WRI�i� BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. Ail calis for inspection shall be made 24 hrs. in ad•,ance- phone 259-$81 5. � <br /> 2. All wak shall be performed in accordance with this permit and curreM City of E�•erett Design and Construction <br /> Standards and Spetifications. <br /> 3. Call Location Underground Service48 hrs.belore you dig.TOLL FREE NUMPER 1-800-424-5555. � <br /> 7`. �'E'PGAG£' �yy G�qM.9G-f=0 CC:�B c�!/.7c.c j� �.�/ O <br /> <EXCE'P�" -SrCtGL G�'i,p iN CU.cB — �O.i�T// E�ve�� <br /> S �/SE Cv,e'o� ,r�.t?f'i.�/ �� G��cv v �S'f�oGr/'yS ♦�A <br /> V♦ <br /> �, 6�',�a�" �.`ar� �S'o /�s �or iE� 7%��F�T O <br /> S'U��DU.v���.r/G ,L n�s Cvi><- :�,;�.✓�t19;C�- �L <br /> �U�+l �h`; <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undcrsigned owner/applicant hereby agrees to hold and save harm� <br /> — less lhe City of Everett Irom any and <II claims for dama�es, costs, <br /> — /— expenses. or causes ol action �hat may 2rice be;;ause of installalion �'� <br /> ����2_ ` � and maintenance of the improvement o� other right�ol-way use hereto <br /> «' �a�plied�for and further agrees lo remove same upon notice from ihe <br /> Approved lor Constructidn� a�e City and to replace public properly damaged thereby. <br /> � . � I / /� <br /> 1 � 7i�3� � <br /> FINAL INSPECTiON Date� �_ ��%���� ��� -� ��'��' <br /> Approved as Consiructed 'Si�naTu�e of App i� ' - . ate � <br /> PUBLIC WORKS DEPARTMENT WORK d.UTHORIZED BY THIS PERMIT MUST BE STARTED WIT�iIN <br /> everett 180 DAYS OF DATE PEFMIT �S ISSUED AND THEREAFTER IS TO <br /> � 3�0^Cedar Street BE DILIGENTIY PURSUED TO COMPLETION. THIS PEPMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATI�JN. <br />