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Dete_� PoElic Warks Per 1• �2^ <br /> C. Appllcation For eiao.oea�.. .�L� <br /> PUBLIC WORKS PERMIT PUE11cWorkaFee I <br /> Tot�l Fee : <br /> Le�e AOV�Fee Pald S--�_ <br /> ' Print or Type Only Bal�nce Due a 30— <br /> 37�T <br />� ,C��os c.�F«� �a���.�y <br /> Owner Meiling Addresa City Zip Phone <br /> �w FF�`'� �n.�prz �Sa�, - /I��S �. �u r— <br /> Applicent Mailing Address City Zlp Phone <br /> DeecribeProposedWork C4,(�tJCG "C C U ✓E/zElO cJ/�LKG1Ji�/ — <br /> (��1R�Jcc� �0,�0�1 ?.E-C� <br /> W <br /> Project Addresa(If known) _ LT � <br /> Attach four(4)rtopies of plena for prcposed work-Draw to scale and note the tollowing es applicabte: � <br /> • PropeMy Lines • Ce�terline of slreet � <br /> •Outline and dlmensions ol all axisting and • Indicate North <br /> proposed structurea on the lot • Show eny proposed grading chenges <br /> • Exlatinp end proposed uNlitles • Show measurements � <br /> DO NU f WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> i. All calls for inapectlon shell be mede 24 hrs In advance-phona 259-887 5. � <br /> 2, All work shall be perlormed In acwrdence with thfs permit end current Clty of Everett Deslgn and Conslructlon <br /> Standa�ds and Specitications <br /> 3. Cell Loc:�ion Underqround Service 48 hrs belore you dig.TOLL FAEE NUMBER 1•800•424•5555. � <br /> S,/ Ao��«,v�- /j7c�f'T �'avi�E A P�,ec�.:tiG A6.eFErn�.r/Y <br /> l�•e F�I-tE"mEn/T �w.� �/..r�•�� A.c�E,4 �uo�eT� aF I�.E'nP�z'ry� � <br /> �/.t/F �.0 f'd.P..CiiVG_ <br /> .S' .s%�' Grio.c'.e- To BE fotis'r��:_^T'F,o PE,l� Q.�f�.eov��,o ��/� <br /> .a�Q,v �3arEo � �9- Bs �// <br /> � <br /> a <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant herehy egrees to hold and save harm• <br /> less the City of Everelt Irom any enu ell cleims for Aameges, cosl4 <br /> / expenses, or cauaes ot action that ^�ay aNse 6ecause of installetlon <br /> / � and mainlenance of the Improvement or other right•of•way uae hereto <br /> applied for and further agrees to reinove same upon notice trom the <br /> r ved Con wtion Date City and to re;�lace public property demaged lhereby. <br /> �uli �.?.�- �6 <br /> FINAL INSPECTION Date 1 <br /> Approved es Construc:ed SIB eture of llppli nt Date <br /> everett PUBLIC WORKS DEPARTMENT W RK AUTHORIZED BY THI ER MUST BE STARTED WITHIN <br /> 3200CedarSlreet 78C DAYS OF DAIE PERMIT IS IS UED AND THEREAFTER IS TO <br /> � Everett,WA 98201 BE DILIGENTLY PURSUED TO COA7PLETION. THIS PERMIT MAY BE <br /> Phone:259•8815 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORI<ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />