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� <br /> Date� , Pu�lm Works Permii� _ � �L <br /> r <br /> Application For eiae�oaoi.� <br /> PUBLIC WORKS PERMIT PueTotelFeeFeo s�o,�— <br /> Less AoO�Fee Paitl S � <br /> Ba!ance Dua S /� <br /> Print or Type Only <br /> �s��e ,n/�.,,r..a' a�60 -7(��c,� S,��E41t�. ����� l,�i�1 9A'c�10 <br /> Owner MaJin�Address City Zip Phone <br /> C�f}-�e�l iii� a3;� c^'n� 4� �D.���/ .�� u,A 9�.�'9 Ce�+-�p�/ <br /> Applicant Mailing Address City Zlp Phone <br /> Describ2 Proposed Work �,��i'AAi1 [I AI �Qy 7� �_', .�/1nc�Y___�,�� /Y N./�= <br /> � <br /> _.r,��ac�r• 1 ,n�,� ��-l+���5 Y c�A� — <br /> _ -- _ � <br /> Prolecl Address(if known) �-��1� �I�'��--.����1jL � � <br /> / / <br /> Attach fuur(4) copies ol plans for proposed work• Draw lo scale and ncte the followiny =^anPlicable: � <br /> U Prouerty Lines • Centerline of sireet � <br /> ! Outline and dimensions of all exisling and • Indicate North <br /> proposed str���':�res an the lot • Show a�y proposed grading chanc;es <br /> • Existing and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THlS LINE � <br /> PERMIT CONDITIONS <br /> 1. A!1 calls fo�insVection shall be made 24 hrs. in advance- phone 259•881 5. �\ <br /> 2. All work shall be performed in accordance with this pennit and current City of Ecerelt Design and Construction ♦ <br /> Standards and Specificatlons. <br /> 3. Call Locatio�Underground Service 48 hrs. 6efore you dig.TOLL FRRE NUMBER 1-800•424-5555. � <br /> '�. /--�i O ff�l'GY�t a �ICFiK.$ �!Gf/"�V 7 G'- � -�b O <br /> � <br /> � <br /> � <br /> O <br /> a <br /> A��� �.�.�dOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold end save harm- <br /> �� tess ihe Cily of Everelt irom any and all claims tor damnges, costs, <br /> �—� expensas, or causes of action Ihat may arise because of installation <br /> �/���j� and maintenanr,e ol the improvemenl or other righbol�way use herelo <br /> � ���r� �r� applied (or and furlher agrees to remove same upon notice Irom the <br /> � Ap%ed o��i n , Date City and to replace public property damxged Ihereby. <br /> /' y��v.� � 1 F <br /> ��'' S- 3 la <br /> fl SPECTiON Date <br /> Approved as Consiruded Signawre oi Applicanl Date <br /> PUBLIC WOFiKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE 3TARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT iS ISSUED AND TH_REAFTER IS TO <br /> � 3200 Cedar Slreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> Everett,WA 98201 CANCELLED BYTHE CITY UPON AIJY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PqOJECT OVER�0 DAYS DURATION. <br />