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�B�B �V � Puenc wo��.P�rmn. ��/ � ✓a�� <br /> Appllcatlon For eiea oso� • ��� <br /> PUB�.IC WORKS PERMIT PUEI¢WorbFee = - <br /> Touliae <br /> Leu�OP�fea PsiA a <br /> B�I�nce Due 5 <br /> c�� <br /> Prfnt or Type Only <br /> � <br /> � a,�nt. � ��L� �c�.ti. �,�1/7 JF f �:-r e.. �� ti 69!'�1 �— �J .� - 77�(� <br /> ��er —T Mailing Atldress City Lp Phone <br /> �, <br /> �L�'--� .�_ � <br /> qpplicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work -�y� . � �-1 r���� <br /> W <br /> Pro�act Addrese(il known) — � <br /> Aftach lour(4)copies ol plans lor proposed work- Draw to scale and note Ihe lollowing es applicable: � <br /> � Pro,�erty Lines • Cenlerlina ol sireat � <br /> • Outll��e end dimenaions ot all existing and • Indicate North <br /> proposed siructurea On the lot • Show any proposed grading chenges <br /> � Ezislinq and proposed utilitles • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEFNIT CONDITIONS O <br /> 1. All calls for inspection shall ba meda 24 hrs In advance- phor,rt 259•881 5. � <br /> 2. All work shall be perlormed in accordenca with ihis permit end current Cily ol Everett Design end Consiruction <br /> Standerds and Specilications. <br /> 3. Call Location Underground Service 4B hrs. belore you diy.TOLL FREE NUMBEP �•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ! ACKNOWLE�GEMENT UF CONDITIONS <br /> (�''�1N�� The undersigned owneUapplicant hereby agrees to hoid and save harm� <br /> less Ihe City ot Eve�ett Irom any and all cleims for damages, cosls, <br /> �/� ezpenses, or causes ol ection ihat may eriee because of installation <br /> c� _�,����� �/�C and maintenance ol the improvemenl or other rigM�of-way use hereW <br /> � 1'� applied lor and lurther agrees to remove same upon notice from �he <br /> Approved lor ConsiruClion Date City and�replace public property damaged thereby. <br /> � �.6.� 7`���� <br /> FINAL INSPECTION Date � <br /> App�oved as Construcled SiBnatwe ol Applic nt Dale <br /> everett PUBIIC WORKS DEPARTMENT WORK AUTHORIZE BY THIS PERMIT MUST BE STARTF.D 1NITNIN <br /> � 3200 Ceda�Slrr.et 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER tS TO <br /> BE DILIGENTLV PURSUED TO COMPLETIOM. THIS PERMIT MAV BE <br /> Everett,WA 9B201 CPNCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�AB15 PROJECT OVER 90 DAVS DURATION. <br />