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, <br /> Date—_ -. . v�ei�owa��sv,.._,• . ---- _ <br /> ApP���ation For Biau Deo� + <br /> PUBLIC WORKS PERMIT °°°:e,aFee�eP $ ',=% <br /> tr.55 Foo�Fee Paid g <br /> ifaia•cr.�u� � <br /> Print or Type Only <br /> ( . <br /> -.� � ni TL-ii ri-i' t %: _� <br /> Owner Mailing Address Gty Z�n Pi�on� <br /> l . <br /> + �� � f/� �- -, <br /> ��� � 1✓,c�7 . � i' Y !C� �- �.�,� �_J���„ <br /> �,'J Applicant MaiJ�hgAddress Cdy L�n Pnone <br /> � , <br /> Describe ProPosed Work -. �{ 1�C' I : i)"1 i/f"C U= lJt��f,i�- <br /> / <br /> W <br /> ProlectAddress�ifknown) 11,�:� �"�� . ��i; 'r?:�/ � <br /> � <br /> Atlach low (4) copies of plans lor Uroposed work•Draw to scale and note ihe follcwing as applicablc � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions ol all exis�inc� and • Indicate North <br /> proposed slructures on ihe lo� • Show any proposed yradiny chanycs <br /> • Enisting and proposed ulilities • Show measurements � <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 ::59•881 5. � <br /> 2. All work shall be performed in accordance with this permit and cwreN Cify ol Everett Des�gr and Construction <br /> Stnndards and Specilications. <br /> 3. C,�II Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> OI <br /> �w ', <br /> �/ <br /> O � <br /> a <br /> ACKNOWLEDG[MENT OF CO'rDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> --— . less the City oi [verett Irom any and all claims for damages. costs. <br /> e+epenses, or causes ot action that may arise because ot installation <br /> -� -=�ti� and maintenance of the improvement or other right�ol-way use hereto <br /> ��. . <br /> __ � - - � - aUPlied 1or and furthei agrees to remove same upon notice from the <br /> Apprevcd lor ConsVuction Date City gnd to replace public property damaged thereby. <br /> . �, . -- _�. ,' _ <br /> � . i �, �.. p . . - . ,�'�J � <br /> FINAL INSPECTION Date �' � -� � '� � � '� -- - <br /> Approved as Consiructed Signalute of Applicant ��� - Date <br />� ovrrrti PUB�IC WORKS OEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 180 DAYS OF DATE�PERMIT IS ISSUFf7 kND THER[Af"TER IS TO <br /> � 3200 Cedar Street 8E DILIGENTLY PURSUED TO CO�df'LGTION. TI113 F'CR�dIT 1.1AY �C <br /> Everett,WA 8tlYU1 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJGCT OVER 90 DAYS DUPATION. <br />