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Date � i�-9� <br /> run6c�vorks rernin., �_ <br /> ApP��c=.tion For BItl9.DCp�.e <br /> PUBLIC WORKS PERM �1' P�e�;�Wo,k=Foo <br /> Tolal Fec S <br /> Less qppl.Fee P�itl �u��__ <br /> Print or Type Only e��a��po�,: 5___ <br /> // ,�� ���C�v <br /> d�,�� Own r�71�/Y-��/�/��5 C' � � "Yf7� �f/ <br /> � Mailing Addre55 C�ty /(3 / /— <br /> Z�p Phone <br /> r ,��/li <br /> Applicant Mailing Address City <br /> �) Z�P Phone <br /> / . � ,v � y� � <br /> Describe Propose VJork � . �/ r �/� � , <br /> _ 2 � 1-�-�� ��/'�!/ <br /> -,�- - <br /> Proiect Address(if known) ��/ " �5 - � � <br /> Attach four(A) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Properl,Linr.s • Centerline ol street _ <br /> • Outline and dimensions of all existing and • Indicate North � <br /> Proposed struc�ures on the lot • Show an <br /> S Existing and preposed utilities Y proposed c�rading changes <br /> • Show measuremenls <br /> �w�o � <br /> DO NOT WRITE BELOW TF;IS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction � <br /> , Stanrjards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NIIMBER 1-$00•424-5555. <br /> � <br /> ��O-{:.. I'�C Cn�� � V C C{ — �/ <br /> U <br /> I i=.1 � \�uc�`� C.c:��c.�- � �- <br /> C c. �y � <br /> l p <br /> � .SC\VP_� �`r-rr� :t.� �/ <br /> �� icl�c�� � o <br /> �{ -Z� _`/ l �° <br /> ACKNpWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City of Everett from any ano all claims for damages, costs, <br /> expenses: or causes of adion that m�y arise because of installation � <br /> and maintenance of the improvement or olhe� righbohway use herefo <br /> Approved for Construction Date applied for and further agrees to remove same upon notice from ihe I� <br /> City and to replace public property damac�ed Ihereby. � <br /> FINAL INSPECTION � <br /> Approved as Constructed Date ��� il_//�/ <br /> Signalure of Apph� nt `y Date <br /> d�� PUBLIC WORKS DEPARTMENT WORK AUTHO�t1ZED BY THIS PE IT MUST BE STARTED IyITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br /> Everett WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT �dqY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WpRK ON THIS <br /> Pf10JECT OVER 90 DAYS DURATION. <br /> � <br />