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Date_�l c�=l v I �"� r � a��o��wo,ws a,.� ����0_ <br /> ApP��cation For oinq Depi . .� <br /> PUBLIC WORKS PERMIT P°°�,°,°°��s��° <br /> ,o�,�F�� s_ <br /> lessAnpl FocPmd 5 <br /> palanri.[1oc .S <br /> Print or Type Only — <br /> ��p��P� c���� ��c i rA� <br /> Owner Mailin�Atldress C�ty 7_�p Phone <br /> ApplicaM Atailing Address City Zip Phone <br /> Describe Proposed Work ��� � 1 A `� `�-�� - �„I D ��C L ^�-' <br /> ? W <br /> Prolect Address�il known� - — — - �`��Q � C � � <br /> Attach lour(4) copies ol plans lor proposed work� Draw to scale and no�e the following as apPlicahle: � <br /> • Property Lines • Cenledine ot street � <br /> • Outllne and dimensions of all existing and • Indicate North <br /> proposetl sUucWres on ihe lot • Show any pruposed c�rading changes <br /> • ExlsGng and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current Cily of Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Localion Underground Service 48 hrs.betore you dic�.TOLL FREE NUMBER 1•800•424•5555. � <br /> I 1('�T 1-�'� . ' �!!:; /� � <br /> > �`�_ ; � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEAtENi OF CONDITIONS <br /> The undersigncd owner/applicant here6y a9rees to holA and sive harm� <br /> less the City of Evere�t Irom any and all claims br damac�es, cosis. <br /> eapenses, or causes of action that may arise because of installation <br /> and maintenance ol ihe improvement or other righbol�way use hereto <br /> applied lor and turth��r ac�rees to remove same upon no!ice from Ihe <br /> Approved for Conslruction Dale Ci�y and to replace publlc property damaged thereby. <br /> FINAL INSPECTION � Date — <br /> Approved as Constructed Sic�nature ol Applicant ���� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTC-R IS TO <br /> � 3200CeCarStreet BE DIUGC-NTLY PURSUED i0 COMPLETION. THIS PER�11T MAY BE <br /> Everett,WA 99201 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 �AYS DURATION. <br />