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Datef/1-49It t0 POSTING S - 2 5 ,s <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pubile Werla Perm,t • 9 <br />Bldg Dept. •._. <br />PobLc Worla ree <br />iolnl Fee f► <br />Leal cool Fee Pmd S <br />Balm,. D., 8 S — <br />)01L)CLI, C'I2P. <br />Owncl hlamm, Ar,Wess t fl <br />' Zin Phnne. <br />Th-C 20clivG L'o, Pa.Bac�7o �c�sor 3 S��c.�,s✓,�,98i�� ZGtS— <br />Apphcanl Madinq Address City .'�n 3r.r63 _ <br />Phone <br />Describe Proposed Work Lr2 <br />LUProject Address (if known! - ^-/•� '1 <br />Attach four 14) copies or plans for proposed Work - Draw 10 scab; and nct r , ,q as applicable; <br />• Property Lines ietw <br />... �, I _ <br />• Outline and dimensions of all existing <br />C,ne of street <br />ng and • r•u ,�.. Nnrih <br />proposed structures on the lot • Im;losed grading changes <br />• E• Istmn and proposed utilities • Sh .—ments <br />DO NOT WRITE BELOW THIS LINL <br />PERMIT CONDITIONS O <br />1. All calls for inspection shall be made 24 his. in advance • phone 259.8810. <br />2. All work shall be Performed in accordance with this permit and current City of Everett Design and Cc,nstructlon <br />Standards and Specifications. <br />3 Call Location Underground Service 48 lira, before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />Ills <br />AG/(�i�V.V.'''LQpG[nycN T OF CONDITIONS <br />The undersirmed ownilSNppllca"ant hereby agrees to hold and save harm. <br />I less file City of Everett from any and all claims for damages, costs. <br />e aPenses. )r causes of action that may arise because of Installation <br />and mamlonance of the improvement or other right-of-way usP hereto <br />Appr ad Co ru on Date - I • 5Nhed for and further agrees to remove same upon notice from the <br />Cityand to replace public property damaged thereby. 1 �/ <br />S N Date "4� r <br />Approved as Constructed Signature of Applicao Dale <br />0wrPUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />3200 Cedar Street 160 !JAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Everett. WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Phone: 239.8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />