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.� <br /> �- -t <br /> fr .. � a-� ----- ___—_ <br /> Date 7� � � r��ou�wo-ksaE-m�i. — <br /> eiaa.oea�..���.�._ <br /> Application For __. <br /> PUBLIC WORKS PERMIT PubToaF¢oFee $ <br /> LessACN�Fee Pala g_ � <br /> Balance Uue $ <br /> Print or Type dnly <br /> InA ^ J�J {1 /^ �8� ctlr��wc«�Q s�- /� �f�s-s4�a-�3��� <br /> �1'/�Y p.P�/ " �YT LC. rQt.tw A l��_y��"'—.— .— �C��/n n�.r� �� �����L�-- <br /> ' O`vn r Mailing Address - Cit� Zip Phone <br /> z <br /> 0 <br /> �fi.t��- � <br /> City Zip Phone '–' <br /> Applicanl Mailmg AAdre.� � <br /> m <br /> Deecribe Proposed 1Vork <br /> rd.ua.�� Gim.f211.B�1s-'��-l��L�-�L — � �� <br /> ... --� <br /> N S <br /> m <br /> W = � <br /> mo <br /> n <br /> Project Adaruss(if known) —" � � m <br /> -1 z <br /> � m � <br /> Attach four(4) copies of plans for propused work- Draw to scale antl nole the lollowin�as applicable: � M <br /> • Property lines • Centerline of streel ,p = <br /> • Outline and dimensions of all existing and • Indicale North � <br /> proposed structures on the lot • Show any proposeJ greding changes � _ <br /> • Existing and proposed utilities • Show measurements M '" `" <br /> W -I N <br /> < <br /> „ <br /> DO NOT WRITE BELOW THIS LINE O o a <br /> PERMIT CONDITIONS �m <br /> �1. All calls br inspection shall be made 24 hrs. in advance-phone 259•SBl S. m � . <br /> 2- All work shall be performed in accordance with this permit and cu:rent C iry ol Everett Dssiy:and Construction y <br /> 0 <br /> Standards and Specifications. � � <br /> � 3. Call Location Underground Servics 48 hrs. belore you dig.TOLr_pREE IdUMBER i�500•424•F555. � c y <br /> m � <br /> ,�:� O � � <br /> /�O f UG�/iC G��02�5 f���/�n�i� �'ECsiG✓�� �- n <br /> �'/ �G � -� <br /> _ <br /> D <br /> 'w Z <br /> _I � <br /> r.=-� <br /> o N <br /> Z <br /> O <br /> a � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OFCONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ot EvereU from any and all claims lor damages, costs, <br /> expenses, or causes ol aclion �hal may arise because of installation <br /> and mainlenance of Ihe improvement or other right•o4way use herero <br /> applied lor and further agrees to remove same upon notice Irom the <br /> � Approved lor Construction Date City and to replace public properry damayed thereby. <br /> FINAL INSPECTION �a�e � Date <br /> Aoproved as Constructed Signature ol Applicant <br /> WORK AUTHORI2ED BY THIS PERMIT MUS'( BE STARTED WITHIN <br /> everett PUBLIC WORK:i DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AtJD THEREAFTER IS TO <br /> • � 3200 Cedar Sireet BE D�LIGENTLY PURSUED TO COMPLt:TIOM. THIS PERMIT M�Y BE <br /> Everett,WA 98201 CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 ' PFlOJECT OVER 90 DAYS DURATION. <br />