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r <br /> �1 <br /> � <br /> 8te_tl`7� PuEI¢Workc Pcrmn s � �l� <br /> Application For Biap.Deou ' oZ O <br /> PUBLIC WORKS PERMIT PueTotalFeeF� s- a - � <br /> + LeqAppt Fee PeiE 5_ \� � <br /> Print or Type Only BalanceDue s — � —' <br /> �/ ,/� // / jOLl�J <br /> �u.^.�-Yo�/ f<. /7/r7'cJG �< yl0 y l-il GY !" �l�o� :Si'—/,l 7`f I <br /> Owner MaihngAddress City Zip Phone <br /> �yos�.�.Vu �,i /� ��UG,� yGl/% le «1 �.'l'e..�i1J ��'ZU,S �S j/,�7�f � <br /> Appiicant Maiiing Address City Zip Phone <br /> Describe Proposed Work /J ✓' <<� �(�C w_ �owcr.. w7�. /-'/_�,c ,G ���-,,5/� � <br /> ProJect Address(if known) s�� y ���� '�/ � <br /> i � <br /> Attach tour(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol;treet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot � Show any proposed grading changes <br /> • Ezisling and Nroposed utilities • Show measurementa � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for insp=ction shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be peilormed in accordance with this permit and current Ciry of Everett Design and Construction <br /> Stendards and Specifications <br /> 3. Cali Location Underground Service 48 hrs. before you dig.TQLL FREE NUMBER 1�800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> � a <br /> r ACKNOWLEDGEMENT OF CONDITIONS <br /> I� The undersigned ownedaoplicant hereby agrees to hold and save harm- <br /> i jless the City ol Everett trom any and all claims lor dnmages, costs, <br /> / expenses, or causes of action Ihat may arise bewuse of installation <br />' �/r F� and maintenance o� ihe improvement or other right•of•way use hereto <br />� roved for Construction Date applied lor and further agrees to remove same upon notir,e irom Ihe <br /> City and to replace public property damaged ther7eby. � <br /> L �_�-'� � c-/1�-d' � �//_ // / _ <br /> NAL I�ON Date ,ex���f'-(3�_� �Y—Il�-✓�/✓ [' -i:uJ <br />', Approved as Conslruded Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTNORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Streel 18D DAYS OF DA7G PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE�ITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PR(IJECT OVER 90 DF�YS DURATION. J <br /> • � <br />