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: <br /> D ate_�:,L_¢��G n�m�.wo-w,r..o���i. '/ c <br /> Applicatio� �or Biaa o�a� y—�P� ��no5� <br /> RUBLIC WOl�KS PERMIT PubiicWorxsFne <br /> � Totni Fee S -- <br /> LusAppLFeePe�a $ <br /> Print r Type Only e��,�.00�o s <br /> l��/ 9 �ssocic.'�n�_ $u��e ,�. (�!r�nC3 I�n;na F'elcl �vernN- I�//� 8� y �y3-7(�o/ <br /> Owner A ailin�A r�ress City Lp Phone <br /> SarY1 Z <br /> Applicant Mailing Address City 2ip Phone <br /> DescribePropcsedWork �'en�nf �mllf��jN1An� .Snu���_,n,n� f�/nu� l/���G�p✓ren� <br /> �� <br /> ��1 W <br /> Project Address(if known) �D/.7l �YP�lYfPP� -Su, 1 �LS /�h c� � <br /> Attach four(4) copies of plans(or proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street ♦� <br /> • Outline and dimensiors ot all existin9 and • Indicale North V� <br /> proposed strucW res on ihe lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 2;59•881 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current City of Everett Desigr.and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOL�FREE NUMBER 1-800-424-5555. � <br /> �!/�c i C G lJG'J'.� �E:c?i��i% .CJO� .(�`c�C1i.C�El� O <br /> �//9� � <br /> , -� � <br /> 0 <br /> a <br /> ACKNOWLEDGEMEiJT OF CONDITIONS <br /> The unders�gned owner/applicant hereby agrees to hold and save harm- <br /> � less the Ciq� of Everet� from any and all claims for damages, costs, <br /> expense,, or causes ot action that may arise because ot installation <br /> and maintenance of ihe improvement or other righPobway use !:ereto <br /> applied for and further agrees to remove Same upon notice Irom the <br /> Approved for Construclion Date City and ro replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cor:lructed Signature ot Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PUASUED TO COMPLETION. THIS PEFMIT MAY BF <br /> Everett,WA 98201 CANCE�LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�0815 pROJECT OVER 90 DAYS DURATION. <br />