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M��I.F 4t . :F{I.Pi�. ' ... . _ `_ ��� . <br /> I . . . . �.`.�� .�. . ���� � <br /> Date� '� , , . � v�o�,�wo�k.ve, <br /> d� <br /> �� ApplicationFor , eiaeoeo�.• �1tY ;_ <br /> �` PUBLIC WORKS PERIVIIT -- — <br /> I PubLc Wvk�Fee _ <br /> iTOtAI F!C '4 <br /> i . LeSs Apol iee PaiO S <br /> Print or Type Only ea�a��ao�e : //0 7.?? <br /> I ;'� - <br /> � � � �� a I �I 1 � � �}�' �U� 9f_�Ol �,��8R <br /> O r Mailing Address �� -.; Cily��, -. Zip Phone <br /> ,i <br /> r�� �'l �, ���,���i ni� ����� C��I(� a �;� � G�'�o i ����1�� <br /> Applicant aiTing Address City Lp Phone <br /> Describe Proposed Work � �1'.� � ^�L..�d �� `� �G�� � 1 �r7 ,� i� ���� �f� V.�_ <br /> W <br /> Prolect Address lif known� � <br /> Attach four(4) copies ol plans lor proposed work- Draw to scale and nole the following as applicable: � <br /> • Properry lines • Cen�erline ol sireet � <br /> • Outline and dimensions of all enisting and • Indicate North <br /> proposed structures on the lo� • Show any proposed grading chan{;es <br /> • Existiny and proposed ulilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> ' 1.All calls for inspection shall be made 24 hrs.in aGvance-phone 259•8870. � <br /> 2.Ail work shall be peAormed in accordance with this permit and current Ciry of Everetl Design and Conslruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you di� TOLL FREE NUh;BER 1•800�424•5555. � <br /> 5'; �S',�.� ��r�.E .� �� �/.hz �¢� �'1"�''� ,o.l.-� O <br /> �%!z`� �.y�-69 CC'�t,•� a.z`rr�erE'� ) <br /> � <br /> � <br /> � <br /> a <br /> I ACKNOW�EDGEMENT OF CONDITIONS <br />' The undersigned owner/apU��cant hzreby agrees to hold and save harm- <br /> less ihe City of Everell irom any and all cinims tor damagas, cosis. <br /> _._/i'�- � ezpenses, or causes ol aclien that may arise because ol inslallatlon <br /> «'S . ..� � /._ /�/l.9� and maintenance ot Ihe imProvement nr other righbot�waY use hefeto <br /> � K�! PJ>�^ applied for and furlher agrees lo remove same upon notice Irom the <br /> Approved lor Construcfion Date City and to replace public property damaged thereby. <br /> �j(� i <br /> �f�J � ` l Q <br /> FINAL INSPECTION Da�e �� `\� ' � �� �� ����5' � J '1 !-� � <br /> Approved as Constructed SignaW re of Appli nl - — D�e <br /> everett PUDLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS i0 <br /> Everett,WA982U1 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Phone:259�8610 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />