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_- . <br /> Date ��� � i+� <br /> PuDI¢WotlB Permll• <br /> Application For eieq oeP�..gr7 a���4(,J <br /> PUBLIC WORKS PERMIT P�OI�CWO�k6FCB <br /> To�a�F�� s <br /> Lesa Aoo�.Fee Paia S _ <br /> Print or Type Only BalanceDue s _ <br /> a.�-5��. <br /> �ver�C� �/�w�� �Iu-�Gi. /�/ai /-��_�✓ Gv-� q�ao � <br /> � Owner ldadmg Address City Zip Phone <br /> ��� <br /> pphcan� Madmg Address Cily Zip Phone <br /> Describe Proposed Work (-�G(6� iWC.CJ �� —/1Q//j�)�Ql� <br /> P�oject Address(il known) L�7 � __ � <br /> Attach four(4) copies of plans tor proposed work� Draw to scale and note Ihe lollowing ;s applicable: � <br /> • Property Lines • Cente�:lne ot street � <br /> • Outline and dimenaions of all exist;ng and • Indicate North <br /> ; proposed siructures on ihe lot • Show any proposed grading changes <br /> � • E risting and proposed utilities • Show measwemenis � <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 /> 2.111 work shall be performed in accordance witb this permil and current City of Everett Desi;�n and�onstruction <br /> Standards and Specifications. <br /> 3.Call location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBEH 1•800•1124•5555. � <br /> O <br /> � �1���. LCld76`�3 �/Yhu.� � <br /> /r���` /��--�-��.{.�- (n <br /> ���,������-- Q <br /> ,, -.30 -90 a <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> ?he undersigned owner/applicant hereby agrees lo hold and save harrm <br /> -- less the Ci�y of Everelt trom any and all claims lor damages, cosis. <br /> expenses, or causes of action Iha� may ariae 6ecause of installation <br /> and maiNenance of Ihe improvement or other right-of-way use hereto <br /> Approved for Conctruclion Date applied for and furiher agrees to remove same upon nolice from Ihe <br /> City and to replace public property dama�ed thereby. <br /> FINAL INSPECTION Date <br /> Approv?d as Const�ucted Signa�ure ol ApplicaM Date <br /> everell PUBLICWOFKSDEPARTMENi WORK AUTHORIZED BY THIS PERMIT 61UST BE 3TARTED WITHIN <br /> � 32o0CetlarStreet 180 DAYS OP DATE PERfd1T IS ISSUC-D AND THEREAFTc� IS TO <br /> Everett,WA�J8207 BE DILIGENTLY PURSUED 7U COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED B1'TfiE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER�0 DAYS DURATION. <br />