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r <br /> � � <br /> !� �•dte � ` �8^�J' PuElic Waiks Permi�x �� <br /> � Application For 8109�Dep�.• <br /> � PUBLIC WORfES PERMIT ��37� P�ercworwsrae <br /> I//� TOIeI Fne s <br /> i� I-a� LessAOPLj ePaiO � /� � <br /> i <br /> 6alance Due S <br /> Print or Type Oniy — <br /> 3 'i5 I�C'Ssoe. ,nsz.:-S. (��pc C3 "�.�r.�F �['`�.��� 1.. �.�c.crc W �. 4 �tc�� 34'1-dooc <br /> Owner Mailing Address City 2ip Phone <br /> Applicant Mail�ng Address City Zip Phone <br /> Describe Proposed Work S�`^' � T'� ''� <br /> � <br /> W <br /> Project Address�if known) � �—�i Po . �r ���L .�• S��>•+�c C�+r..^(L. � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable:r � <br /> • Property Lines • Centerline ot street � <br /> � • Outline and dimensions of all exisling and • Indicate North <br /> proposed structures on the Ict � • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /M ' <br /> W <br /> DO NO'f WRITE BELOW THIS LINE � <br /> PERMIT CON�ITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259-881 5. wq <br /> 2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction ♦ <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-500•424-5555. <br /> � , <br /> �. �.�,- ����`��'S O <br /> �� - ��,� �sk.� � �-- <br /> �''� ,�� �.�, �_ ��- N - �� �� N� <br /> ��� � <br /> �.� '� � � � ��,,� a <br /> ,�,�-� ,�;�,-�-°`^�`°� ���-� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> �er� / + � expenses, or causes of action that rtiay arise because of installation <br /> � /j j y and maintenance of ihe improvement or other right-obway use hereto <br /> `"'t''GX/1' �^�8� applied for and further agrees to remove same upon notice from the <br /> ApP�o�ed tor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date � --�— � <br /> Approved as Constructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERIv11T MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLE:7iON. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY TNE GTY UPON ANl'���OPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DUR:'-ThJN. <br /> � <br />