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Date �—c� PuOhc Work�Permit �.. <br /> Applitation For ema.oeu�.+ <br /> PUBLIC WORKS PERMIT P�°,o„F��FeB s r-�.� <br /> �ess noo�.Fee vaa S�_ <br /> Pr:ntorTypeOnly BaianceDue s /.33 '�__ <br /> �1��nt�5 c�' �m�p1�Xl a8�1� A!L ��`��ri" �-3i�J <br /> Owner Mailing Address City Zip Phone <br /> .�,L����1 � 1I�'Z- 1`��Ji}} ra�Y�" qR7d�1 .�' -� — <br /> Applicant Maili�ig Address City 2ip phone <br /> Describe Proposed Work 7 If%_�.� � fi�UJ�7 ' <br /> � -- <br /> � <br /> i <br />� W <br /> Project Address�if known� 2���— B�'�OAD(1)A� � <br /> Attach four�4) copies ol plans for propoeed work• Draw to scale ar,d note the follow�nq as applicable: � <br /> • Proporry Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> propesed slructures on the lol • Show any praposed grading changes <br /> • Existing and proposed u�ilities • Show mr.asurement, � <br /> DO NOT WRiTG BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ot Everett Desian and Construction <br /> Stnndards and Specifications. <br /> 3.Call Location Underground Service 4d hrs.6efore you dig.TOLL FREE NUMBER 1•S00•424-5555. � <br /> ,F� �....v- a�onr-•-�c��o(a�s ���� 2 - 2.3 • F38 O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWL�DGEMENT OF CONDITIONS <br /> The undersigned owneUapplicaN hereby agrees to hold and save;iarm� <br /> less the City ot Everett Irom any and all claims lor damages, cosis. <br /> � =� - expenses. or causes of adi�n that may arise because ol insallatien <br /> � and maintenance of th= improvement or other right-of-way use hereto <br /> A rq ed for Co ructiun applied for and furiher agrees to remove same upon notice Irom Ihe <br /> � Date Ciry and to replace public proper�y damaged thereby. <br /> � ��—��'" �o �r �� "� �r�..� <br /> FI CTION pa�� 1 "t' � �� '� 1'�'e <br /> Approved as Constructed Si a re oi Applic 1 Date <br /> ever��tt PUBLICWORKSDEPARTMENT W AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200:'eonr5irett 1 DAVS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> Everett WA 9E207 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELL[D BY THE CITY UPON ANY STOPPAGE OF\NORH ON THIS <br /> I`ROJECT OVER 90 DAYS DURATION. <br />