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---� <br /> i <br /> � <br /> I <br /> Date��3 Pu�ncWmbPermit• � � I <br /> Olea Daot • �� " — I <br /> Applice�ion For � <br /> PUBLIC WORKS PERMIT Puei�cWarkeFee s� <br /> Totel Fee <br /> .� Q � � <br /> CL/��4 Leee RpP� �ee Po�J S ���— <br /> Beience Due S <br /> Print or Type Only �,yry3, <br /> �w/'P�''��� N/1 �G��� LISL �-IIG�� �9w� /}iE rL�r'-rr.r c� Z�-�r LSL - 1Y .5 � , <br /> Owner Melling Address City Zip Phone ' <br /> �.�M f <br /> Applicent Meiling Add�ess City ZIp Phone <br /> DescriGeProposedWork �rtT�k L /Isp�r�+�r {���Nri��/1YJ. 'h�i.� f�qRlT�rL f ���P� �� <br /> W <br /> Prolect Address(il known) `�Z C � <br /> A�tech lour 14)coples ol planc lor proposed work- Draw to scele end nole ihe lollowing es nppliceble: � <br /> • Property Lines • Centerlina ol sireet � <br /> • Outline and dimensions ol ell axisting and • Indicete North <br /> proposed siructures On ihe lot • Show eny proposed grading chenpes <br /> • Existing end V�oPosed utllities • ShOw measurementa � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls la inspacllon shell be made 24 hrs.in edvence•phone Zb9•88�5. � <br /> 2. All work shell be perlormed in eccordance with this pe�mit end currenl City of Everett Desi;n enA Consiruc�ion <br /> Standards end SpeciHcetlons. <br /> 3. Cell locatlon Underground Sarvice 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACNNOWLEDGEMENT OF CONDITIONS <br /> The undarsiyned owner/applicanl hereby ngiees to hold and seve hnrm� <br /> � less Ihe Clly ol Everet� Irom any and all cleimb lor dameges. costs, <br /> �� expenses, or causes of action that may erise b��ceuse of Instxlletion <br /> 8� Z I,r and meintenance of Ihe Improvement or other dbhl�obwey use hereto <br /> applied for and furiher agreos to remove same upon nolica Irom ihe <br /> ed or Conslrudion � / �e�e City and to replece public properry dameged�heraby. <br /> ��..,��1��- .�-.-'-� y 1ri,—��ly(/��(/ t� - �S <br /> FINAL INSPECTION Date � /� � -"� —� <br /> Approved as Constructed Signature ol AppGcent Dete <br /> evrrett PUOLIC WORKS DEPARTMENT WORK AU7HORI7ED BV THIS PERMIT MUST BE STAHTED WITHIN <br /> � 3200 Cedar Slreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evewll,WA 9�201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phono:259�BB15 CANCELLEG OV TN6 CITY UPON ANY STOPPAGE OF WORK ON THIS � <br />( PROJEGT OVER 90 DAiS DURATION- <br /> � <br /> ! . <br />` <br />