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� <br /> �' nate_/��y <br /> Paellc Works Pe.mi1+ ��/�� <br /> APPIic.Non For Bmo.oeo+..�y��'yQ/ <br /> PUBLIC WORKS PERMIT PublicWorksFee <br /> Totsl Fae S �- � O <br /> � lecs Appt Fee PeIE S <br /> Print or Type Only Bei�nceDue S `�'��� �' CJ �*� <br /> �7° u-' 6 <br /> �fl K�C P�" �(,i��i n ti,.� -�i l� ( c�R ( ��57' .l3(c% �cm�Z 1f 9'rau/ �5-9- Y/`// <br /> C Malling Address <br /> p Phone <br /> �e �(��v�� n�„ cr�� � 4�(d� �A�P � �� �/! /� <br /> APPllcant� MeilingAddress �� `��( ' � �' � C���� ���0�b %' �7 $� <br /> CitY Lp Phone <br /> Oescribe Proposed Work /�PM n c�P � Q X/S�/1 N{ •b��a� �� p�..� ' <br /> �CC � <br /> �ro�ect Address(if known) � � ( � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Llnes • Centerline ol street _ <br /> • Outline and dimensions of all existinp and • Indicate Norih � <br /> proposed struclures on the lot • Sliow an <br /> • Existing antl proposed utilities Y ProPcsed grading char�oes <br /> • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CON�ITIONS O <br /> 1. All ca�ls for inspeclion shall be made 24 hrs. in advance- phone 259•681 5. <br /> 2. All work shall be perlormed in accordance with this permit and wrrent City of Everell Design and Construction ' <br /> Standa�ds and Specilications. <br /> 3. Cell Locetion Underground Service 48 hrs. before you dig.70LL FREE NUMBER 1-$QO•424•5555. <br /> `f. �F'�"r.9.E'S' �3P�P�nJG <� — ` Q�, r � <br /> / O N ��/v SJ�Ls� O/ /� � <br /> /�GLc�� t(J,A�f� NJT fj��P7'�E' '✓E�'y G.✓J�O G/il'CLIC.97To�, <br /> �� aC �,,�=� �y ���,��y�.-� o.�,�y �' <br /> — �U % <br /> F'� `'�`,�L�c �rsc_ V♦ <br /> O <br /> a <br /> ACKNOWLEDGLN[NT UF GONDITIONS <br /> ' The untlersiyned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett from any anc all claims lor damages, costs, <br /> expenses, or causes ot a�tion ihet may arise becauso ol inslallali0n <br /> :�*� � �and mainlenance of Ihe improvement or other right-oFway use hereto <br /> Appr ed uclion / Date applied for and further agrees to •emove same upon notice; Irom the <br /> __�r.� Ciry end to replace pubiic property damaged thereby. <br /> :✓ -�„- ��' ��Lv �- t`/�� /,l� /� <br /> FINAL IPoRPECTION� � Date "� <br /> • Approve�es Conslructed %� / � �Ze <br /> ---" ' Sipnature ol ApplicaN /� Date <br /> rverMt PUBIJC WORKS DEPARTMENT WORK AUTHORIZED BY/FHIS PERMIT MUST BF. STARTED WITHIN <br /> � 3200CederStreet 180 DAYS OF DATE PERMI� IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE GILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE pF WORK ON THIS <br /> PROJECT OVEFi 90 DAVS DUKATION. <br /> L J <br />