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^ T �/'<'rf-S <br /> , � <br /> Date�� � <br /> � Pu�lic Works Permit• �7`'��,,, <br /> Application For Biea oeo�.•-�„7� (Yy�j'L <br /> i <br /> PUBLIC WORiCS PERMIT P�o���wo«sF�a <br /> Total Foo �_ <br /> Less A00�Fee PaIC s <br /> Pflflt Of T BalancoD�e $ <br /> ype Only <br /> Te�rAh�.n�rr < 3a7G-//r,�}'' .(/F ��a��,�e �s3 —n; �� <br /> Owner Mailing Address Cit;� Zip Phone <br /> �.�� ✓p 3 3 P--G9,� <br /> ..��!!(11ic�TC�.,r�f P,,� 1 a5'� 3S�/�.����,�1��/1f �F2�`B' <br /> pplicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��Gaf� �M 11_✓)f�.1/Q:�/,Q/�' �/G/" �-7�h �� <br /> ��— <br /> s�q3s W <br /> Project Address�if known) ��.t_ �1_ /P� /Af � <br /> Attach four(4) copies of plans lor proposed work• Draw to scale and note Ihe(ollowing as applicable: � <br /> • Property Lines • Cen�erlinv ol s�reet /w <br /> � Outline and dimensions ot all existing and • Indicate �Jorth v, <br /> proposed structurzs on the lot • Show any proposed grading changes <br /> • Existing and proVosed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls!or inspect(on shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current City ol Everett Design and Consiruction <br /> Standards and Speci(ications. <br /> 3.Call Location Underground Service 48 hrs.before you di�.TOLL FREE NUMBER 1•800•424•5555. � <br /> /�'Gc-L.�c�� ��m..��- ���2i>zc-'��f�ey, �/- ,� O <br /> Y ��7�z��es � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CON�ITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett hom any and a�l claims for damages, costs, <br /> expenses, or causes ol action that may arise because ol installalion <br /> and maintenance ot the improvement or other right•of-way use hereto <br /> applied lor and (urther agrees to remove same upon notice Irom tlie <br /> Approved lor Construction Date <br /> Ciry and to replace public properry damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Signature ot Applicant Date <br /> everett PUBLICWORKSOEPARTMENT WORK AUTHORIZED BY TH�S PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarS�reet lA0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet6 WA98201 BE DILIGENTLY PURSUED TO COA1PLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />