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/,r, <br /> Date ��Lf�?�%�"� �u�hc WorFs Pcrmlt y <br /> / <br /> ' 4pplica�ion For dltly.Dep�.a_ <br /> PUBLIC WORKS PERMIT' P°°��°W°�sF°a $ <br /> Total Feo <br /> Less Fv Fee Paia $ � <br /> �a� ce o�e $ <br /> Print or Type Only J� 5��.,�# 3��_��` .� L� <br /> $-q�( <br /> Owner Mailing Address City Zip Phone <br /> �o►�sr. a�'.io�. Pd �.Is�s i�v�Nwvo.� q8o3So "774-34's�► <br /> .4pplicant Mailing Address City Zip Phone <br /> Describe Proposed Work Puv�P_�..��� r t�TL'� ��'M �T�_�LT 'r0 Rl.i��-n�NG, <br /> � <br /> 'flj � �c7 C'f� i!o/J P � " Lf /�CiF' C%c�/�-C L,7''C c7 /� <br /> E2=,ec—,—T �Ji9G� ��f7Y — ��/'/'�> - y �<%��ri�f-i�<<-� _ _ <br /> �`_""� 9r ��/,74J�c��r.E��'C��r�J /�✓T�Es'c�T�2��J _ W <br /> Prolect Address�if known) � <br /> Attach four(4)copies of plans tor proposed work- Draw to scale and nofa the following as applicable: � ' <br /> • Property Lines O Centerline of sireet � <br /> • Outline and dimensions ot all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposad grading changes <br /> • Existing and proposed u:ilities • Show measurements � <br /> DO NOT WRITE BcLOW THIS LINF <br /> PERMIT CONDI71!�NS O <br /> 1. All calis for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit and current Ciry of Everett Desiyn and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-000•424•5555. � <br /> �/ �S"l�'nlS//�i9�t=,'•- co�Tlc'c�C /'�-`-��. O <br /> �=�c_c � /�JJ'l'c`c-%�-'�E'. <br /> �� /�-✓�c:.7, ,..-�',S-� �, .S �' �� n />>� , ^� / � � <br /> ,�� � <br /> a <br /> AJKNOWLEDGEMENT OF CONDITIOtJS <br /> The undersigned owner/applican�hereby agrees�o hold and save harm- <br /> less the City of Evera;t from any and ali claims for damages, costs, <br /> �/ . .---" ', 7 expenses, or causes of action that may arise because of installation <br /> .!� 4�r1 `�/`-��' �_7�K../—� end maintenance of the improvemenl or other ri�ht-ohway use herero <br /> � applied tor and further agrees to remove same upon notice irom the <br /> Approved'(ocGnnftr�un .' Date City and to replace public properry damaged thereby. <br /> - _ � / <br /> FINAL INS CT!'JN 'Da�e' <br /> Approved as Conslructed ig ie of App,i Date <br /> everett PUBLIC WORKS DEPARTMEN OR AUTHORIZED BY S RMIT MUST BE STARTED WITHIN <br /> � 3"�"0 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98207 BE DILIGENILY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-88?5 CANCELLED BY THG CITY UPON ANY STOPPAGc OF Wf��' � <br /> PROJECT OVER 90 DAYS DUFATION. <br />