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r. <br /> � <br /> �il� �✓//� /��/ :. y���- <br /> .l.—I— • /Y Pu01¢Wo�k�Permil• <br /> Biap.Deu1.e � � _ <br /> ,o Application For <br /> � <br /> � RU�.IC WORKS PERMIT PUCIKWorksFee <br /> iotal Fee s <br /> � Lep RpD�Fee PeiC S <br /> � 00 �O g � BaianceDue S 2aOd <br /> Print or Type Only a � '�' <br /> j.i� ��� �� ��3=�� <br /> N <br /> °° /h � -/ 7�rd � r,r,z���7��9�f� <br /> wner � c.i dleitie9 Address Ci�y ip Phone <br /> � o o.- �1� w <br /> D�.��� � �� � o � <br /> qpplicant Mailing Address Cdy Lp Phone <br /> Oescribe Proposed Work �� ��� <br /> �^ W <br /> Prolect Address(if known) `� � � <br /> � <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note fhe following as applicabie: � <br /> • Property Lines • CeMerline of street � <br /> • Outline and dimensions ot all existing and • Indicale Norih <br /> proposed siructures on ihe lot • Show any proposed grading changes <br /> i • Existing and proposed utilities • Show measurements <br /> ���'� DO NOT WRITE BELOW THIS LINE � I <br />� O�'ERMIT CONDITIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance•phone 259-8870. � <br /> 2.All work ehall be pertormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACY.NOWL[DG[MENT OF CONDITIONS <br /> ' � The undersigned owner/applicant hereby agrees to hold and save harm� <br /> . — less the City of Everetl irom any and all claims lor damages. cosis, <br /> eapenses, or causes of action that may arise hecause of insfallation <br /> �� /f z z 9 and maintenance ol ihe improvement or olher righbof-way use hereto <br /> Da���� applied for and turther agrees lo remove same upon notice from Ihe <br /> Approv=d br Cons udion a�e �ity and to replace public property damaged thereby. <br /> ��� �'� � �/ �� � � <br /> FINA� INSPECTION �a�e ibate <br /> Approved as Co�structed Sign urn of Applicant , <br /> W K AUTHORIZED BY TNIS PERMIT MUST BE STARTED WITNIN <br /> evrrett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERPAIT �d�Y F3E <br /> Everett,WA 90201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJC-CT OVER 90 DAYS DURATION. <br />