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_ �✓ <br /> �,� -� <br /> �Date '� � P�,�,���w�,hsP�,m� D � � <br /> qpplication For eiag o�,n� � ��I�� <br /> PUBLIC WORKS PERMIT' P°°��°W°��°°ie -- <br /> To�a�Fee 5— <br /> less/p01F.>Panf S—��— <br /> vJl(lmtn puC .r1 <br /> �l•.J(jV <br /> Print or Type Only <br /> / � I/ ��,_�� <br /> , I ' � <��.��r����"`�r1 ��� <br /> /rOwner ! �'ailingAtldress City Zip P ne <br /> Applicanl Mailmg Address Gity Lp Phone <br /> Descri5e Proposed Work � r _ <br /> �it//� /�LTE�.i %��i�i:�i.-=/.iLl/ l=i�Ti.=-'7n��r-_ — <br /> - W <br /> Prolect.4ddress lit known� <br /> ,� � - � <br /> A�lach four(4)copies of plans for proposetl work- Draw to sc�f e and note Ihr, lollowin s applicable: � <br /> • Property Lines • Centerline ol s�reel � <br /> • Omline and dimensions ol all exisling and • Indicate North <br /> proposed structures on ihe lot • Show any proposed yrading chang�s <br /> • [zisling and proposed ulilities • Show measurements � <br /> DO IJOT WRITE BEL _./THIS LINE O <br /> PERM�T CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•$81 G. � <br /> 2.All work shall be pedormed In accordance with this permit and current City ol Everelt Design and Conslruction <br /> Standards and Specificalions. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �t� The undersigned ownedapplicant hereby agrees lo hold and save harm� <br /> less ihe Cily of Everetl from any and all claims for damages, cosis. <br /> � expenses, or causes of action thal may arise because ol installation <br /> C��� � �?�i and maintenance of lhe improvement or other rightrohway use hereto <br /> ������ "-`�J-�' ! applied for and furtl greec to remove same upon notice irom the <br /> Approved lor Construc�ion � Date Ci(y and to rep e pu � property dama9ed �hereby. <br /> /�iG-C-CI � �' L/-tFl ( C � <br /> FINAL INSP[CTION Date � � • 7 8 <br /> Approved as Constructed Signature ol ApplicaM ���� <br /> everell PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY S PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Everett,WA99207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�&810 PROJECT OVER 90 DAYS DUNATION. <br />