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�a�e�, { t;. i <br /> `�`� Pu�Lc Wa�Fs Pe�IDll a , <br /> -,�� ,=:.Z I�''�C <br /> Application For oiea oeoi-+ �= - _ . <br /> PUBLIC WQRKS P�' RMIT P�°;o,aFoeF�° S_ ---- <br /> lessApP��Fec PaiO S _ <br /> Print or Type Only e�����e o�� s _ <br /> I=L.I��'11�G(J'l�� 5��11T -` 1 1/�i � <br /> Owner Maifing Ad rass Gly Zip � Phone <br /> �J.,t�l'�lZ <br /> Applicant Mailing Acdress Cily Zip Phone <br /> :�� / -}- _' l� � i ' <br /> Describe Proposed Work ���C'l.�-�/-�� 1 C- �7������ � <br /> i <br /> Project Address(il known) _ �( '��l Il7 �L� t"i� r� � <br /> Attach four�4)copies of plans for proposed work- Draw lo scale and note ihe following as applicable: � <br /> • Properry Lines • Cenlerlire ol street � <br /> • puUine and dimensions of all existing and • Indicale Norih <br /> (�.roposed siructures cn the P:�I s Show any proposed grading changes <br /> • Existing and proposed utilitias • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calis(or inspection shall be made 24 hrs.in advance- phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design avd Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. S <br /> L <br /> � <br /> H <br /> I� 1.L�� �'E�C� � <br /> � <br /> ,�� � <br /> � <br /> / ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save h2rm- <br /> � less ihe Ciry of Everett from any and 311 claims for damages. costs, <br /> / j expenses, or causes of aclion Ihat may arise because of installation <br /> ���� antl maintenance of ihe improvement or other rignt-of�way use hereto <br /> App o ed lor Cog ruction Date applied for and turiher agrees to remove same upcn notice irom ihu <br /> � / Ciry�nd to replace public properiy damaged Ihereby. <br /> � <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 780 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> [veretl,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Ph�ne:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIiIS <br /> PROJECT OVER 90 DAYS DURATION. <br />