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, � v„���,���,�„ks��,�,�� � _P��i�-�K%-- �, <br /> Date���i� _�9 /L' _ <br /> E3qf9 Dcf��.• / L_�.��— <br /> qpplication Fcr <br /> PUBLlC WORKS PERMlT `'°°°`W°,"s`r° -------- — <br /> ,o�,�F�� 5— <br /> lessanN.Feevnia S _—_. <br /> 6alancc Oue S <br /> �' <br /> Print or Type Only <br /> Cr�6�,+ l� . . �",c� /fe0lX� /Yl,�l ('�Pn�/� YYI,/l/'iopl� 4,Pdra 7�1S-D� 3d <br /> � - ' -- Mailing Nddress City Zip Phone <br /> Owner <br /> J(� '�1 Q Phone <br /> Applicant Mailing Address Gity ZiP <br /> ����i�.._I�' tt2t.�„_�j�' "�-b <br /> Describe Proposed Work � � <br /> -- W <br /> Prolecl Address(if known) <br /> S�l� — � ��+ �u�; ,.�; _ � <br /> e� <br /> Attach�our(4) copies o� plans for proposed work- Draw to scale and note ihe Ioltowing as applir.able�. � <br /> • Prope�ty Lines • Centerline of streel <br /> • putline and dimensions ol all ezisting and i Indicate Norih <br /> proposed slruc�ures on the lot • Show any proposed grading changes <br /> • Existing and proposed u�ihties • Show measure«�eNs M <br /> W <br /> DO NGT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shal�be made 24 hrs.in..dvance-phcne 259-8810. <br /> 2 All work shall be perfurmed i•i accordance with this permit and current City of Everett Design and Construction <br /> Slandards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.hefore you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLC-DGEMENT OF CONDITIONS <br /> The undersigned ownedapplicanl hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, custs, <br /> expenses. o� causes of action lhal may arise because of installalion <br /> ���_�1�/i_ .. �/_ /�,_�i, and main�enance of ihe improvement or o�her riyh�-obway use hereto <br /> � F���� t applied for and further agrees to remove same upon notice Irom Ihe <br /> Approved for Constru/c�t�on / Date City and to replace public property dama9ed thereby. <br /> C�S/C�G—� ���G � � �i/� � <br /> � <br /> FlNAL INSPEGTION �a�e ��'"'�` �� Date <br /> Approved as Consirucled Signah�re of Applicant <br /> WORK AUTHORIZED BY THIS PEHMIT MUST BE STARTED WITHIN <br /> everet[ PUBLICWORKSDEPAR'fMENT 1g0 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br /> � 3200CedarSircet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,N�'A 9A201 CANCELLED BY THE CITY UFON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />