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C3fe��`� 7 <br /> � <br /> v�n�i��wn�..n.,mn.J_ ' (,�. <br /> Application For eio� o«n� � =�._ i�`- <br /> PUBLIC WORKS PERMIT <br /> r�m¢wm4 Fec <br /> iolelFee a <br /> �- <br /> Print or Type Onty ���s�pol fee PeiC a� <br /> Bahnrn Due $ <br /> L�l(.oL�;L�� ����� �(�/��� �� � i� 1 ��r, i i � /- <br /> MailingAtldress tp1 `� �� ���n�\� <br /> CiIY Zip <br /> � � Phone <br /> -1...�_ <br /> Applicant Meiling Address <br /> City Zlp Phone <br /> Deacribe Proposetl Work _ f 11-tk.�'�[ � �r�'<K <br /> � <br /> Pro�ecl Addrese(il known) � ' - � � � W <br /> Aflach lour(4) coplea ol plens lor proposed work� Draw to scale and nota the following es epplicable: � <br /> • Property Linee <br /> • Outllne entl dimengions ol all exisling antl � Centerline ol sfreet � <br /> proposad etructures on the lot � Indicale No�th � <br /> • Exisling end proposed utilities � Show eny proposed grading changes <br /> • Show measuremenis <br /> DO NOT WRITE BEL(�W THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspectlon ehell be mede 24 hrs. in edvance-phone 259•88�5. <br /> 2. All wo�k Bhell be performed in eccordance with this permif and current City ol Eve�ett Design and Construction <br /> Standerds end Specificatione. � <br /> 3. Call Locatlon Underground Servlce 48 hrs. balore you dig. TOLL FREE NUMBER 1-800•424•5555. <br /> ���/C- Cs�C,,�',�t- �.fmiT /fIOT � <br /> �'�9- B�l s�� � <br /> ��``/ � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> —' The undersigned owner/epplicent hereby agrees to hold and save harm� <br /> less Ihe Cily of Everett hom eny and all claims br damagas. costs. <br /> end ma ntenpnce olgihe mP��emen o�olhee r�ighl of way u et hereto <br /> APD��ved Ip�Con9�ruC�ion pafe applied Ior qnd furthe� agrees to remove seme upon nopce �rom th= <br /> Cify end lo raplace public property d�ma�ed �hr.reby <br /> FINAL INSPECTION <br /> Approvetl as Constructed Date <br /> Siynalure ol AnPlicxnt -- <br /> PVPIP�I PUBUC WOFKS DEPAqTMENT WOHK AUTHORIZED BV THIS PERIdIT MUST BE STARTED WITHIN <br /> � :i200 Cedar Slreet t80 DAVS OF DATE PERMIT IS ISSUED AND THEqEAFTEi� IS TO <br /> Everelt, Wq ggpp� BE DIUGENTI.V PURSUED TO COMPLETION. THIS PERMIT Mqy yE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION <br />