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_T ao-z9- s <br /> n p^1 87- y8 <br /> 8te- -/�' I-y� 1 PUEI�<Wod�Parmil• <br /> aS�LL1J <br /> Applicatlon For Biap.Dept • --- <br /> PUBLIC WORKS PERMIT °°°ro�:FeeFee s — <br /> I.nu�oa�Fee Peie S <br /> D n�r <br /> Bal�nce Due s � <br /> Print or Type Only <br /> ����h l��tb�l yb�,"1 ��uY�'�AU� �i���rr ��ao3 �5�—��� <br /> Owner Malling Addrasa Ci y Zip Phone <br /> pppli,ca1n� MellingAddress City 21p Phone <br /> Dascribe P�oposed Work i T,.y.;,_!l.lU��� - <br /> W <br /> Pro�ect Addresa(lf knuwn) <br /> '�� '�� ^'^"^ ' '"� ?207 A $ B CN,EST.✓UT � <br /> Attech lour(4)copiea ol plane lor proposed work•Draw lo scele and note the following as apFlicable: � <br /> • Property Llnee • Canterline ol atreet � <br /> • Outline end dlmenaions ol ell existing and • Indicale Norih <br /> propoaed atructu�es on the lot • Show eny proposed greding chenges <br /> • Existing end proposed utllllies • Show measurements � <br /> DO NOT WRITE BELOW 7HIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor I�spection ahell be mede 24 hrs. In advance•phona 259�881 5. � <br /> 2. All work ehall be pe�formed In accordance with Ihis permil and curre,it City of Everett Design and Construcllon <br /> Standerds end Specllicetions. <br /> 3. Call Locetion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•555rJ. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> `�.�� _ The undersig^ed owner/applicanl hereby ag�ees to hold and sava herm• <br /> less the City ol Eviirett from any and ell cleims for damages, costs, <br /> expenses, or ceuses ol action that may erise because ol inatalletion <br /> « /� /J� a �7 end meinten8nce at the �mprovemen� oi other rlght•ol�way use hereto <br /> .O Oe�t applieQ.foi end luriher egrees o remove same upon notica Irom ihe <br /> Approved lor Con ruct�on . �a�P City�nd to replece publi p�op ty demeged thuraby. <br /> �� � �������Jc� ,,? - �i-�� <br /> NSPECTIO Date <br /> pproved as Conslruclod Signatute ot Applicant <br /> evere[I PUBI.IC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STAR7ED WITHIN <br /> 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLE710N.7HI5 PERMIT MAY BE <br /> Everatl, WA 98201 CANCELLED BY THE CITV UPON AN�STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />