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�� App6calion For � / I <br /> � PUBLIC WORKS PERMIT — — - � <br /> Data.-_--i i=u/'1 i; <br /> P B I RKS DEPARTMENT Public Works Permi�p � /������ <br /> T(1 POSTING 'JUN lE��o����ezo;`S�z5�.aa,o _. <br /> � Building Pe�mit M_,___�ii_I!�.i <br /> TYPE OR PRINT ONLY Public Works Fee 5 `-''� 1 <br /> I ,. I. !.Ui.r.o I1 ;vS /ll�. ��l .��. ..�. :�71,....�., �IuLS(1 �:��. .��yi <br /> Owner Mailing Address City Zip Phone <br /> Applitnnt Madmg Adtlress City Zip Phone � <br /> , Describe Proposed Work _ �+��. �.ui.:,:; — isr.s,c : ; i i <br /> . -- W <br /> _ - _ h- <br /> - <br /> � PROJECT ADDRESS(if known) __r' . `��1 ' � Cj, wT � SLGItT P1.A'f 12-9� � <br /> '�. Attach four(4)copies of plans lor proposed work-Draw to scala and note the�following II npplicable: � <br /> •Property Lines butline antl dimenslons ol all existing nnd proposed siructures on Ihe lot •Ezisting and proposed utilitie, O <br /> •Centedine of sireet •Indicate North •Show any proposetl grnding changes •Shm..neasuremerts � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS� � <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> � 2.Atl work shall be pertormed In accordance with this permit and current City of Everett Design and <br /> I Construction Standards and Specifications. I <br /> I 3.Call Location Underground S�rvice 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. � I <br /> �/ <br /> ; O <br /> � a <br /> , <br /> � <br /> � / ACKNOWLEDGEMENT OF CO�vDITIONS <br /> . � / Thc undersigned owner/applicant hereby ag�a�s to hold und saae harmless <br /> "� ��(_l �� � � L.(, ,.�/v ����� Ihe City of E�erett Imm any and ell claims for tlamages,costs,e�penses,or <br /> �. Approved lu�Cons tion p��e � wuses oi acf�on that m.ry nrise because ol Installation and maintenance ot <br /> �� the improvemint or other right-of-way use heretc applied for antl lurther egrees <br /> to remove sar�e upon notice Irom Ihe City ar,d to replace pu6lic property <br /> � �Y.- - -�—'. . ��lp -r/� damaged therf by. <br />` I FINAL INSPECTION Uate <br /> I Approved us Constmctetl - �� , , <br /> I` <br /> SignaWre of Applicnm Data I <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED ANf7 THEREAFTER IS TO 6E DIIIGENTLY PURSUED TO i <br /> � COMPLETION.THIS PERMIT MAY BE CANCELLED BV THE CITV UPON ANY STOPPAG[Of WORN C-�;fH15 PiIOJECT OVER 90 DAVS DURATION. <br /> I <br />� I <br />