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1 ' <br />�Date�� — v J Public WorkaGermil+ �� ��� <br /> ' Application For BiOg.Dept+ <br /> ' PUE3LIC WORKS PERMIT PuEbcWorksFee <br /> Total Fee S <br /> Lesa ApO�Fee PeiC S <br /> BaienceDue S �� �-10 <br /> Print or Type Only <br /> � Fl rnrE sY50N �/yos s 3R� G'7��ar/1 %pao3 �--G:�� <br /> Owner MailingAddress City 2ip Phone <br /> c��1 r��c-' /n c s�-n,� Yy,r, s �R° CUi-R�1� yy�.�3 25� -�'���- <br /> Applicant � Mailing Address City Zip Phone <br /> Describe Proposed Work ��lf /C�NC/� �/U ���� � l��i711/l C,.� AS� <br /> y� '� f�//,'H �6� /=C/=T AR��4n�0 R/L/�/NC� i I <br /> iF = i - O � i <br /> W ; <br /> Project Address(it known) � I <br /> Atlach four(4)copies of p�ans for proposed work-Orew to scale and note lhe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions oi all exis�ing and • Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • �aow measuremenis � <br /> ►. <br /> DO NOT WRITE BE� �:W THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with ihis permit and cur:ent City ol Everett Design and Construction <br /> Standards and Specilications <br /> 3. Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 1•800-424•5555. � <br /> �/, .ryr'r/1� .�a.e.—ic,r� oF TirF- FF,✓cE T.,�ar �S i.vs:a�t E� O <br /> /y/.s�E' P�.Siit �F'�G-y%- o�'_G;/.dr Ti��T /NLii�llE.eS <br /> F�r�,eE P���'GiC 1/nr3C'�✓E�ccn,7%J /7%t�ST �E .C'Ei7>v✓EO � <br /> fJT Ti/E A/'/'[iCdN%.S' E{�ENSE , <br /> � <br /> O <br />� a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to h��d and save harm- <br /> less the City ol Everett Irom any and all claims lor damages, costs, <br /> �� expenses, or causes of action that may arise because of installation <br /> ��� �a /�_��� and maintenance of the improvement or other ri;hPOFway use hereto <br /> �� applied for and furiher agrees to remove same uPon notice irom Ihe <br /> d"proveG fo��o ction Date City and to replace public property damaged thereby. <br /> � � , - � Z�S. <br /> FINAL IN TI N Date � <br /> Apprcved as Constructed � nature ot Applicant Date <br /> e��erett PUBLIC WORKS DEPARTMENT ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 780 DAVS OF DATE PER�tIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 8E DILIGENTLY PURSUED TO COMPLETION. THIS PFRMIT MAY BE <br /> Phone:259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />