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Date 7 �� � 1 Pubti:Wmks r'ermit• <br /> Applicatiun For eiao.oro�.+�,.5! . <br /> PUBLIC WORKS PFcRMl7 P�blicWorksFoe -- <br /> Totnl Fee � _ <br /> Less AVf��Fec Pald S <br /> Balanco Duo $ <br /> Print or Type Only __ — <br /> R 9R /�ssocia�e9 -Su�ye A 3fc1� �-3 /��:�n� F,'e%l, F_ve;el� �/��G�l 7y3 -7 ,0/ <br /> Owner Mailing Address City Zip Phone <br /> Same <br /> Appiicanf Mailing Address City Zip Phone <br /> DeScribeFropoSedWork �'�nnn�- �M�P�� �ni�}] ��n � a�D>n ,�p,,���1• sq(Z�� (;y-'K`�� <br /> ./ � <br /> p�oject Address(i(known) �(11�7 I EVL�f�_��nn n p���Q_ l� � <br /> J � <br /> Atlach four(4)copies of plans for proposed work- Draw to scale and note the following as applicabie: �� <br /> • Property Lines • Centerline of slreet `dw <br /> • Outline and dimensions of all existing and • Indicate I�orth d�, <br /> proposed strucWres on the lot • Show any aropoceG qrading chany�rs <br /> • Existing and propused utilitiea • Show measmeTents � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. A!I calls for inspection shall be made 24 hrs. in advznce- phone 259•881 5. � <br /> 2. All wcrk shall be perlormed in accordance with this permit and current City ol Everett Deslgn and Conslruction <br /> Standards and Specificalions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FI?EE NUMBER 1•800•424-5555. � <br /> �UrauG Cdl.��-s yE,�ir,T .c.icr ,c�c��,,eE.1J ^ <br /> y�.j�sG � <br /> �l,�r�' � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanf hereby agrees to hold and save harm- <br /> less �he Ciry of Everelt irom any and all claims for tlamages, cosis, <br /> expenses, or causes of action that may arise because of installation <br /> and mainlenance of lhe improvement oi other right-of�way use hereto <br /> applied for and furiher ac�rees to remove same upon notice Iwm the <br /> Approveo tor Construction Date Ciry and to replace public proper;y dama9ed thereby. <br /> FINAL INSPECTION ,atc . <br /> Approved as Construc�ed Signa�ure of Applicant Date <br /> �verett PUBLIC WJRF�S DEPARTMENT WORK AUTHORIZED BY THIS PERM�T MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED A�'U THEREAFTER IS TO <br /> Everett,WA 9820� Bc DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phcne: 259�8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK Ot�7HIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />