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� . <br /> Date_��,�.8� � fJ'(o "�O/ <br /> vuohc Wo�t,Permit. <br /> Application For eiap o�ai.. <br /> PUBLIC WORKS PERMIT Pubb�WorbFee <br /> To,s�F« s <br /> �ess nooi Fee ae�a S <br /> Prini arType Only <br /> eaianceoue S 35�� <br /> Owner Mailing Address City Zip phone <br /> Gas.�v ��,Usr.c �'o onx ���9 E�F.��-r 9B �'6 ^ �B 3hG. 7 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ���5>,r- ii � .o �i� C�vv Qr-,t- ��g - � ,t�i nr <br /> � i('Fn�0.0 v L A.c/ �I�OCJ '� �iJ/GO/.t/G <br /> W <br /> Projecl Address(il known) E �' -i '� � <br /> Attach four(4)copies of pians lor proposed work•Draw to scale and note the lodowing as applicable: � <br />� • Properly Lines • Centerline ol sireel � <br /> • Outline and dimensions of all ezisting and • Indicate Norlh <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � i <br /> UO NOT WRITE BELOW THIS IINE - O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be r�ade 24 hrs. in advance• phone 259•881 S. � <br /> 2. All work shall be perlormed in accordance with ihis permit and curren�Cily ol Everetl Design and Consiruclion <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•4?4•5555. � <br /> � �firF wc,.;f- ->c. 6'E IJ,�>.✓�_ /�F,� �'�o; �'���•� � O <br /> .l�F�TElJ � !J�dF o✓�� `/-B- 8!> <br /> f �. � <br /> �! ' � <br /> � � <br /> u � �;�`�� ' � <br /> d ,— <br /> .e,� <br />�'� � �� a <br /> � � <br /> ; <br /> , , <br /> ACKNOWLEDGEMENT OP CONDITIONS <br /> The undersigned owner;applicant hereby agrees to hold and save harm� <br /> less the City ot Everett Irom any and all claims tor damages, costs, <br /> �_�-' �% expenses, or causes ol action that may arise because ol installation <br /> / -y'/. and maintenance ol ihe improvement or other right-of�way use hereto <br /> '�Z� 5�� ' ?�� "'� �� ' " �� applied for and lurlhe� agrees to remove same upon notice Irom the <br /> APproveC lor Cd'nstructi Date City and to replace public property damaged thereby. <br /> FINAL INSPC-CTION Dale �� � � � � -� `��- 4� - � � � ' ��✓—' <br /> Approved as Constructed SignaWre ol Applicanl Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED OY TNIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />