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Date��(o ��o�,�wo,ws P�,m�� <br /> Applicalion For Fnao�u�o�.• � <br /> PUBLIC WORKS PEF�MIT PublicWorksFoe <br /> Tolel Fen $ <br /> . Less AOP��Fee Paid S <br /> Print or Type Only BalancaDue S <br /> � 79�KflGia7P.5 .S� ����G_�_7_ lfiirGr�� F��/�h` Y(lo�lYS� 7� — 7/9r?� <br /> Owner Ma�g Atl6ress City �ip Phone <br /> S� ,M � <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Woik �('Nf.N� iMa(Tr✓ALtf!'s(T_�1�7-� /f�i� ]'/�/ii�L' KR'J/'� K�/J��Drf ^ <br /> � "7'7` <br /> W <br /> Project Address(ii known) _I(��� E-�[Psg��a�_/,(��•1 � <br /> ��_ <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note ihe following as applica6le: � <br /> • Properry Lines • Centerline of street /w <br /> • Oulline and dimensions ol all existing and • Indicate North V, <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and Froposed ulilities • Show measuremenis � <br /> DO N0T1h'RITE BELOW THIS LINE <br /> PERMIT C6NDITIONS � <br /> / 1. All calls 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 City ot Everett Design and Construction <br /> Standards anA Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �l/8L/G L�/o.�T pF2.niT ,tJI�T ,�'c�� u��E"D � <br /> 7/��5� � <br /> �/ Y/ <br /> V <br /> a <br /> ACKNOWLEDi•EMENT OF CONDITIONS <br /> The undersigned o�•:ner/applicant hereby agrees to hold and save harm- <br /> less fhe Ciry of EvereU from any and all claims tor damages, costs, <br /> expenses, or causes of ar,tion th2t may arise because of installation <br /> and maintenance uf tha improvement or o�her righ�-of-way use herelo <br /> appliad for and furthar agrees to remove same upon notice trom the <br /> Approved for ConsVuction Date City and to replace Uublic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalure of Applicant Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI?ED BY THIS PERMIT MUST BE S7ARTED WITHIN <br /> � 320UCedarStreet �80 DAYS OF UATE PERMIT IS ISSUED 4ND THEREAFTER IS 70 <br /> Everett,WA 98201 BE DILIGENTLY PURSUED i0 COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�881 5 CANCELLED BY THE CITY UPJN ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS r,URATION. <br />