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L� <br /> Oate�f�3l��� N���,�wo.k�Pe,m��. �'— `7�5�U <br /> Application For Pidg Depl =._�'i��oZ//S S ___ <br /> PUBLIC WORKS PERMIT �°°°°w°��°FBe -- <br /> Total Fee S <br /> Less FppL Fae PaiO S <br /> Baiancn Due $ �� <br /> Print or Type Only — <br /> R ,c{� C' �aF P- ��f�as �V crenl� l�,l.,,,o „ 9�� ��o��ie�/�`fi0�� y&-3 —nQ(19_ <br /> Owner Mailing Address �Ci1Y Zip Phone <br /> S A rvt P- <br /> Applicant Mailln9 Address Ciry Zip Phone <br /> Describe Proposed Work �Gl .S� fIIw� I� �If1 M E. — /JN� (y [��qGI� f-n��f La H c <br /> - p W <br /> ProjBC[Addre55(i�Fnowr.� _ �/ZZ �« ��'d'� �" � <br /> Attach four(a)copies o�pians for proposetl work-Drew[o scale and note the tollowing as apDlicable: � <br /> i Property Li�es • Centedine ot street � <br /> •OuHine and d!mensions of all existing and • Indicate Norih <br /> proposeG stmctures on Ihe lot • Show any proposed grading changes <br /> • Existin9 and prOposed utilities • Show measurements � � <br /> DO NOT WRITE BELGW THIS LWE O <br /> PERMIT CONDITIONS <br /> t.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City o(Everett Design an�Construction <br /> Stantlartls and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 7-800-424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACKI�OWLEDGEMENT OF CONDITIONS <br /> '� The undersigned owneNapplicant hereby agrees to hold and save harm- ��� <br /> less fhe City of Everett from any and all claims for damages. costs. <br /> . eapenses, or causes of action ihat may arise because of installation <br /> ' ,f /5- and main[enance ot the improvement or other righ4oi-way use hereto <br /> applied for and further grees to remove same upon notice from the <br /> Approvetl tor Con tr 1i i /� Date City and to replace p li�property damaged thereby. <br /> � �.� -� �6� <br /> FINAL INSPECTION Date � � � . <br /> Approved as Constructed S nature of App ic n. ate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN ' <br /> everet[ PUBLICWORKSDEPAR7MENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CeAarStreet BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone.259-8810 PROJECT OVER 90 DAVS DURATION. <br />