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� <br /> r �ate r x / Puerc�Yon.s Permit• g 3yG � <br /> Application For Biep.Ceot• <br /> PUBLIC WORKS PERMIT Pu011cWorFeFee <br /> Tol�l Fee S <br /> LessAool Fee Pe�ie S <br /> Print or Type Only e.�a��eo�E s �4,e?!J "j <br /> 7���� <br /> ��Q7 r,rc �M2 �•Y, u r, �'l L .�-e v�c c ,-�r- /�//o j� l �a «a <br /> Owner Mailing A dress City Zip , Phone <br /> /�J�j �'orr-' �i �532 �.uw�v �� dG .. �9c� �� �� T 3s3 � YL.s'�. <br /> Appticxnt Mailing Addmss C' y Zip Phone <br /> Describe Proposed Work ,�p • AI��7�.a-!.� H-�/J <br /> Pro�ect Address(if known) � �� �}G 7 G.� � � / `L /��J �i�/�� � <br /> -- � <br /> Atlach lour(4)copies of plans lor proposed work- Draw to scale and no�e lhe lollowing as applicablc � <br /> • Property Lines • Centerline of sireet 'A <br /> • Outline and dimensions ol all existing and • Indicate Norih M� <br /> proposed siruCtures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDI710N5 <br /> 1. All calls lor inspection shall be made 24 hrs. in advance� phone 259•881 5. � <br /> 2. All work shall be pedormed In accordance with ihis permil and current City ol Everetl Design and Consiruction <br /> Slandards and Specifications. <br /> 3. Cr.11 Location Underground Service 48 hrs. balore you di{�.TOLL FREE NU�18ER 1-800•424•55:i5. � <br /> O <br /> �w <br /> _/ <br /> � <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> . less Ihe City ol Everett Irom any and all claims I�r damr.ges. costs, <br /> // / expenses. or causes of action tha� may arise because ot inslalla�ion <br /> c�{. !/� O /7/�/.�� and maintenance ot Ihe improvement or other righ��of-way use hereto <br /> � 'r�^����'-���? �� appfed for and furiher aJrees to remove same upon notice irom Ihe <br /> Approved for Consiruction �- Date City and to �eplace public property damaged ihereby. <br /> � <br /> �� i <br /> , �� �� � �d� i <br /> FINAL INSPECTION Oate �Y <br /> Approved as Conslructed Signatu e ol Applicant ate <br /> ' everett PUDLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS P_RMIT MUST BE STAFTED WI;HIN <br /> � 3200 Cedar Stizet 160 DAYS OF DATE PERMIT I ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259-NB15 CANCELLED BY'TIiE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br /> L ".� <br /> 4 � <br />