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Date� Public Works Per „. �—I'G <br /> Appliwtion For eiee�oeci•� ' <br /> PUBLIC WORKS PERMIT PuEI¢WoaaFee <br /> Tolal Fee s <br /> Lese ApO�Fee PeiE + yrO_� <br /> Print or Type Only Baisnce Oua e <br /> 37%7 <br /> ,��os ����� �a�co�,�y <br /> Owner ldeiling Address City Zip Phone <br /> �A F F,�i_x_��t rr� �'JS�s�, - /�`-�, 1' � �'�u � <br /> Appiicant Mailing Address City Zip Phone <br />� Describe Proposed Work C L—(it1(C. aC C C)�E�ElO f���LF�(,���/ -- <br /> ( ) (�2 f A�1 = -�O1J_?.E.�'J <br /> - - W <br /> Project Address(if known) _ L fS � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions ol ail existing and • Indicafe North <br /> proposed struCtures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> �� <br /> DO NOT WRITE BELOW THiS LINE O <br /> PERMI7�CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specificatlons. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> y A/�f�GiG'.QNT /Yl�[ST j'�?ovi0�' A �'��.fiyG /�l�.PEErnE=idY <br /> D,�' F./.l'E.�?ENT ��E' L/-fi�+/�s A.('E�4 iUC.�'T/! OF 1�,c�C/'.`X'Yf/ Q <br /> �i�lE �,e �'d.G..e�ivG_ <br /> S ST'E- Gvoi',c- To c4E !c/V.s'T�,a•r.TE',G7 PEf' .Gf'L%c;uE.o � <br /> 1�<:d.�J G�rE.[J � ,�. c_ �y � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to ho�d and save harm- <br /> � �ess the City of Everett trom any and all claims for damages, costs, <br /> expenses, or causes of actlon that may arise because of installation <br /> / � and maintenance of the improvement or other right-ol-way use hereto <br /> r ved r Con ction Date applled for and further agrees to remove same upon notice trom the <br /> /� City and to replace public property damaged thereby. <br /> ���Y� ���' �C� ^ 7 <br /> FINAL IIJSPECTION Date I— <br /> � <br /> Appioved as Constructed Sig ature of Appli nt r/ �ale <br /> evemtt PUBLIC WORKS DEPARTMENT W h�� ��JTHOR�ZED BY THI VL'H MUST DE STARTED WITfiIN <br /> � 3200CedarSireel 780 DAYS OF DATE PERMIT �S IS UED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br />