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Datei��l��(G;�Y� Publk Wo�ks Permii< _ ` S�s� <br /> � Application For 8tdg.Dao�.+— <br /> PUBLlC WORKS PERMlT '���Z� z Pub7ollFeeFee $ ) �66 <br /> Less A00��Fe0 Paid $ <br /> Balanco0ue $ � ' <br /> Print or Type Only <br /> 1� � �� A�CGc: :/�t'G.'� T$Vn 4 C� :� 1'A. i.Jl'. 1—:(=:_i 1 �( C�LGl� 34'7—<t�c7c <br /> Owner Mai4in�Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Desc�ibe ProPoser `Nork . 'rJ�/��� � ��r' )�'-5 U]� --X�v/`tl /-2r1� <br /> Proiect P.ddress(it known) S��T� � � ����-^ L� � G � <br /> � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicabl � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions of all existi�g and • Indicate North <br /> pr000sed structures on the lot • Show any proposed yrading changes <br /> • Existing and pioposed utilities • Show measur=menis /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls for inspection shall be made 24 hrs. in advance-phone 259-881 5. � <br /> 2. All work shall be performed in acrordance wilh 'his perroit and current City o!Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Loca[ion Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> i�. i�e,� ce�>��a-.-Pa���.n S O <br /> / i <br /> � <br /> � <br /> O <br /> a <br /> ACI<NOWLEDGEMENT OF CONDITIONS <br /> 7he unde�signed owner/applicant hereby�grees to hold and save ha�m- <br /> less the City of Everatt from any and all claims lor damzges, costs, <br /> ' expenses, or cacres of action that may arise because of instaltation <br /> �— /� � and maintenance of the improvement or other righbohway use hereto <br /> G applied for and further agrees to remove same upon notice from the <br /> Approved for onstruction Date City and to replace public properry damaged thereby. <br /> S Z� ��'f'Z J��r--ti--- "�_—_ ��6 &:�i <br /> FINAL INSPECTION Date <br /> Approved as Constructed ignature ot Applica t Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMI7 MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF OA7E PERMIT IS ISSUED AND THEREAFTER IS i0 <br /> BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�881� PROJECT OVEF 90 DAYS DURATIqN. <br />