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Date�"�� <br /> �uM1i�c WorFe Per ♦ <br /> APG'iwtion For H4t0 OoPt . ��j�� <br /> PUBLIC WORKS PERMIT r nTole FeePoe s - <br /> lnsaRppl fqePeitl S <br /> Print or Type Only Balnnce0un S <br /> r �. . ��,�;��T ��� � �� � s� � �' �� �,� �� ��q�l <br /> � � . <br /> Owner M- alling q d ss Gty Zin Phone <br /> .�dA_l l� <br /> AppGcant Meiling Address City Zip Phone <br /> Describe Proposed Wo�k ��.������L/ <br /> � , W <br /> Projed Address 1it known) 7 � � <br /> Atlach low(4)copias ol plans�or proposed work- Diaw to scale and note the�ollowing as appliceble: <br /> • Proper�y Lines � <br /> • Centerlina of sheet � <br /> • Outline entl dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measuremenis <br /> DO NOT WqITE BELOW THIS LINE • � <br /> PERMIT CONDITIONS O <br /> 1. All cells lor Inspection ahall be made 24 hig. in advance-phone 259•8815. <br /> 2. All work shell be performed in eccordance wlth this permit and currenl City ol Everett Design and Consiruclion ' <br /> Standards and Specilicetions. <br /> 3. Call Locetlon Undo�ground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•600•424•5555. <br /> ��� �n�l t 12�t �P�i�� Z <br /> r O <br /> � `//������/ / <br /> ira H <br /> �/�i � � V� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant herehy agrees to hold and save harm� <br /> less the City of Eve�ett Irom any and all clnims for dameges, costs, <br />� expenses, or causes ol action Ihet may arise beceuse of inslallation <br /> and maintenance of ihe improvemenl or other righl�ol�way use herelo <br /> Approved lor Conslruction Date epp6ed lor and Wriher egrees in remove same upon nolice Imm �he <br /> City antl to replace public properly damaqed thereby. <br />� FINAL INSPECTION Dafe <br />, Approved as Constructed Sipnalure ol Appli�ant Date <br />� everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PEFMIT MUS7 BE STARTED WITHIN <br />� � 3200 Ced2r S�reet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl WA 98201 BE DILIGENiLV PURSUED Tn COMPLETION. �HIS PERMIT MAY BE <br /> Phone: 259-8E15 CANCELLED BY THE CITY UF�N.4NY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEq 90 DAYS DUFATIGN. <br />