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' <br /> � <br /> r <br /> Date�a / � <br /> AUF�icationFor P'���'�K'orkaPermhs C�S��Sc-/� <br /> Pl1BLIC WORKS PERMIT e1aooeoi• r�s�/�ya a� — <br /> PuElic:Vorka Fee <br /> Totel pee S—�_ <br /> Pflnt Of Typ@ O�ly �eeeRoat Fce P�'itl S <br /> Br:ancoo� �= s_�C �� �, <br /> / % �Y �� � <br /> �7 , r ) l,sf7 <br /> owner 3/ ; 1 <D/.�'� ,/�(� 7- . n� ., _� <br /> �` '(" i <br /> Alailing Adtlresa ��f'-���' LS ��-(� �j '_ <br /> City Z�p <br /> � Phone <br /> L_C;� . i�'p ;t°v<-�.-,/ l y/'/ � , � <br /> APPlicant . � //� �r' ,. . /.�� p �,,, <br /> MailingAddress ' �"�'���'' � � l(.,' j�S�7j / �/�� ��� � <br /> City Zip � _ <br /> � Phone <br /> DescribeProposedWork _/J��'i,; �� -� ��K < , <br /> i -, - '7 i �� ti �,�> / �, <br /> -� i 'r' - i : i .t. <br /> — <br /> �� ' <br /> Project Adtlress(il known) �_5' /�p�),�,�?/./:, �� ir- �- y-� � <br /> r �'� rr i <br /> ,ltlach lour(a� copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines <br /> • Outline and dlmensions ol all existing and � Centerline o(st�eet � <br /> proposed structurPs on the lot � �ndicate North � <br /> • Existing and pr�posed utilities � Show any proposed grading chan es <br /> T Shpw measuremenls 9 <br /> DO NOT WRITE BELOW THIS LINE m <br /> PERMIT CONDITIONS <br /> 7. Ail calls for inspection sNall br,� made 24 hrs. in advance• phone 259•$81 5. � <br /> 2. All work shall be perlormed in accordance with Ihis permit and current City ol[verett Design.:^d Cor,struction <br /> Standards and Specilication:�, � <br /> 3. Call Locatlon Underflround S�rvice 48 hrs, before you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> � <br /> O <br /> ■ <br /> � <br /> O <br /> �., a <br /> _,�I%� ACKNOWLEDGEMENT O�CONDITIONS <br /> The,Undersigned owce�/applicant hereby agrees to hold and save harm- <br /> less Ihe City ol Everett irom any and ail daims for damages, costs, <br /> � / ' e�fpenses, or caus s'b( action ihat may arise because ol installation <br /> - � 7�����'`,-/ <br /> � � �-��... ����'>/�� and mainlenance I Ihe improvement or other righbol-way use hereto <br /> APproved for Construction applied for and rther agrees to remove same upon notice Irom the <br /> ����/ Date Y <br /> Cit and r pl ce pebl�c p operty damaged thereby. <br /> riNAL INbPECTION 7 `F� / <br /> � . � <br /> Date i �� i <br /> Approved as Conslructed � - � ' � /� '�. J ✓ /r� <br /> Signat re of qp �it� j � . � <br /> everett PU9LIC WORKS DEPAqTMEN7 WORK AUTHORIEED BY THIS PERMIT MUST BE STA TED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED qND THEREqFTER IS TO <br /> 6�crett,•Nq gppp� BE DILIGENTLY PUqSUED 70 COMPLETION. THIS PERMI7 MAV BE <br /> Phone: 259•8815 CANCELLED 8Y THE CI7Y UPON ANV STOPPqGE OF WOqK ON THIS <br /> L PROJECT OVER 90 DAYS DUqATION. <br /> ..� <br />