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� <br />( <br /> - _. _. . - : _ - .: - . � <br /> � _. __... ._ . .._ . <br /> t� � <br /> � �a(@ �'- � �C Puel¢worwaPermn+ r%� �� ` � <br /> Application For Biao neo� � --. � <br /> � PUBLIC WORKS PERMIT I PubLtWorkSi¢B � ��- ' <br /> I // Totel Fe•. s �( ', <br /> I �� � �-� le5s Ro��-Fee Vu�O S � <br /> � �Z ! 1 <br /> � /�' OdIBlI[POuC �l , <br /> Print or Type Only ; ,, <br /> � ���� � '!. . l ��•/'-'� . �i '! '%.,: r� I��IF'' � // �� . <br /> � Owner� Mei�ing Address ' City Zip Phone <br /> � � <br /> i � � - .i .i � '�'\ 1ry.-�✓- . ! . j� p;J� � � %' ��I(_(— � <br /> I � Applican� Mailing Atldress Ci�y Zip Phone i � <br /> � " � . �.. � ��-� /�� � /�. � � � � <br /> Describe Proposed Work '��'� � � , "�� 1 , i <br /> �' <br /> i <br /> I <br /> �' W <br /> � Prolect Address(il known) !%���� �� ` ��'i �' ./� . � <br /> I � i <br /> Attach four(4)copies of plans for proposed work- Draw to scale and rote Ihe tollowing as applicable: � � <br /> � • Property Lines • Centedine of s�reet � i <br /> • Outline and dimensiOns of all existing and • Indica�e North <br /> I proposed structures on the lot • Show any proposed grading changes ' <br /> '. • Existing and proposed utilities • Show measurements M �; <br /> ' Y� <br /> i DO NOT WRITE BELOW THIS LINE �i <br /> � PERMIT CONDITIONS � � <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> i 2.All work shall be pertormed in accordance wilh this permit end curreN City of Everetl Design and Cons[ruction � � <br /> ', Standards and Specilications. � , <br /> '� 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•B00•424•5555. � i <br /> I '�i, - �.'-1� f <�. , .�-i r,. ' � �7 '� O <br /> % . <br /> � <br /> i � � <br /> � i <br /> I O � <br /> a ' <br /> � <br /> �. ACKNOWLEDGEMEtJT OF CJNDITIONS i <br /> � 1 hu undersiyned ownedapplican�hereby agrees to hold and save harm� <br /> i — less ihe City ol Everett Irom anv and all claims lor damages. cosis. I <br /> - �- expenses, or causes of action that may arise bewuse of installa�ion <br /> � - . -� and maintenance ol Ihe improvr•ment or olher nghl-of-way use hereto il <br /> , - � — — aoplieA for and luriher agrees to remove same upon notice Irom the <br /> Anpro'ved lor Co�struc �� � ���� City and to replace public prop�;ity damaged thereby. <br /> � � <br /> ,i .r' i� , -. <br /> � FlNAL INSPECTION Dale �-�— ' ' ' .. ._��. `' '�. � � � • � . <br /> � Approved as Consirur,ted S�gnali��e of Applicant Date �� <br /> WG9K AUTHOHIZED BY TI-IIS PEFMIT M11UST BE STARTED WITHIN I <br /> � rvrmll PUBLIC WORKS DEPARTMENI� 1b0 OAY i OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO . <br /> � � 3700CedarSireot I BE DIUGENTLV PURSUtD TO COMPLETION. THIS PERMIT MAY BE <br /> Evercll,WA 98201 CANC:LLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS � <br /> Phonc:259�U010 PROJECT OVER 90 DAYS DURATION. � I <br /> � __ - <br />