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...._�..—. <br /> V8t@��� PUEIic Workn Permlt• <br /> ApplicationFor eieo-oeni... �-�?�(�6 <br /> PUBLIC WORKS PERMIT o�oTo,Wo�eFae s <br /> Less ApD�Fee PaiG t <br /> Print or Type Only B�IanceDue a <br /> 1�.,.i.�v�n ll.,ep !aD l7r�x ] 1�2 � .Ev i � 2u� 2�Zlt� <br /> Own r MaiNng Address �i� <br /> Y Z�P Phone <br /> Oe�a P r <br /> Applicent Ma�ling Address Cilv Zip Phone <br /> DeacribeProposedWork 7pNa.f7 I�M� l7�U(f,�/�p�7� — ,��yoMp�,�� �y���� <br /> Praject Addreas(if known) _ � <br /> Attach lou�(4)copiea of plens lor p�oposed work- Drew to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing end proposed utilities � Show measurements � <br /> DO NOT WqITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> � 1.All culle far Inspeciion ahall be made 24 hra in advance-phone 259�8810. � <br /> 2.All woAc ehell be pertormed in accordance with this permit end curtent City of Everett Deslgn and Construction <br /> �� Stendards and Specificatlona <br /> �� 3.Cell Locetlon Underqround Service 4B hrs,before you dig TOLL FREE NUMBER 1-800�4245555. � <br /> �/�li/G (.�/�D� /��•eJ�iiT Noi .�'f-y�U..�� O <br /> >�� � <br /> //-/S- 8� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harin- <br /> less the City ot Everett Irom any and alt claims lor damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance ol the improvement or other right•of•way use hereto <br /> Approved tor Construction applied for and further agrees to remove sartie upon notice from the <br /> Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSt�eet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259-BB10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />