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Oate��'�� P,,,,���w�,�,��,mo,�. �, �^ <br /> Apphcntion Fo� eina oea� . �.1J .�i�/_ <br /> PUBt.,IC WARKS PERMIT �,"—��° W��"��a , -- <br /> ,�,a��,A <br /> lnef Pppl fee Paitl 6_ _ _ <br /> Print or Type Only BaNnro Due S_ <br /> l'-�A � m� �� L��a� � �� �- �� ,� <br /> Owne� Mailing�ddres� ity Zip Phone <br /> ��Ir-il'. (�(.��#–.�ll',�1�I-�,5� !� ��II [�2���s���3 � <br /> Apohcant � aili Address City� Zip Phone <br /> Describe Proposei Work �_� !' L-f l`i1l�� _ <br /> W <br /> P�olact Addrees(il known) � <br /> Atlach lour�4� copies of plans fo�propo98d work• Draw lo ecale and note the Ioilowing es app6cable� � <br /> • Properry Lines • Cxnterline of alreel � <br /> • Oullina and dimaneions M ell eristing and • Intlicete Norih <br /> p�oposad etructures on iha Iot • Show any p�oposed greding chenges <br /> • Existing end proposed utill!les • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFtAIT CCNOITIONS <br /> 1. All calls for inspection ahall be made 24 hrs in edvance- phone 259•881$. � <br /> 2. All work shall be perlormed In eccoidence with this permil end currenl Ci!y oi Everett Design and Conshuclian <br /> Stendards end Specificetians. <br /> 3. Cell Locatlon Underground Service 48 hrs. belors you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> �� ,��UI�.L'� !��� d <br /> ���� H <br /> � <br /> 0 <br /> a <br /> ACKNOWLEOGEMENT OF GON�ITIONS <br /> The undeisiyned ownedapplicent hereby agrees lo hold and Save harm- <br /> — 'ess the Cuy ol Everett irum any end nll cleims for dam�ges r.osts, <br /> e�nenses. or causes ol nclion thet may erise because ol mstallahon <br /> nrd maintenance of Ihe impiovement or othe� righ�-of�way use herelo <br /> opplied lor end further agrees fo remove semn upon noM1ce from the <br /> Approved lor Conslrucllon Dete Ci�y and to repleca pubGc propeity demaged thereby. <br /> FINAL INSPECTION Dete <br /> Approved as Conslrucled Siyneture oi Applicanl Date <br /> rverelt PUBLIG WORKS UEPART�AENT WORK AUTHORIZED BV THIS PERHh� MUST BE STARTED WITHIN <br /> � 3200CederS�reet 1B0 nAYS OF DATE PERMIT IS ISSUED AND THEREAFTEA IS TO <br /> Everetl. WA 98201 BE DIUGENTLY PURSUED TO COMPLETION. THIS PEHMIT MAY PE <br /> Phone� 25b�8H l5 CANCELLED BV THE CIiV UPON ANV STOPPAGF Of WORK ON THIS <br /> PROJ[CT OVER 90 DAVS DURATION <br />