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Date_,7C�p S PUEIm Works Permp s V�/ /J <br /> App�ication For aia9.oeoi.r <br /> PUBLIC WORKS PERMIT PublicWorksFee <br /> Totel Fee S _ <br /> Less A00�Fee Paid S <br /> Print or Type Only ea�,��ao�a S 3S_� <br /> �u/�nV P.oi2.� `L/Na.KzT Zc�.2sTj '1�J/X� <br /> Owner Mailing Address City Zip � Phone <br /> / <br /> �s�� S�t���=� �o /��X �3� ���� 9��� 3s�=Z�r9 <br /> Applicant Mailing Address City Zip Phone � <br /> Describe Proposed Work � �Q7 5� /� � �OiOvzi.�.,� .y <br /> � ..7" 2. �2� � <br /> Project Address(if known) ��✓�A �,9,c',f� /rlq,p.P��► � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as apUlicable: � <br /> • Properry Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate Nor�h <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> � DO NOT VJRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City:d Everett Oesign and Construc'ion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555 _ � <br /> � , r; iJ�_.. <br /> N/ � S�zv�gu�N Jit/S LL. �o9rA�c� m O <br /> Lf � 9�,Ci9L � <br /> S'�'P.9�ATo,e •� C/ITGiY �B.9SiN <br /> o! ' �i .e L'�73/ S'/l7.d0l�leD '�S�/q //� <br /> � SQ (3Uq,D�N4 \ /F ONE Oo�.1' NoT EXrST, �O <br /> � W , <br /> � •� �� a <br /> ; �. � <br /> �, �- <br /> � <br /> EXISTi/�ks' CB � � ACKNOWLEDGEMENTOFCONDITIONS <br /> � Tlie undersigned owner/applicant hereby agrees to hold and save harm- <br />� less the City of Everett Irom any and all claims for damages, costs, <br />� / expenses, a causes of action that may arise because of installation <br /> I � � and maintenance of the improvement or other right•ohway use hereto <br /> i� Ap r ved for C on Date applied for antl further agrees to remove same upon notice irom the <br /> d to replace public roperty damaged thereby. <br /> FINAL INSPECTIO � pate .. n� .�p�1��[..�— �� <br /> Approved as Constructed , Si ature ot App icant <br /> Date <br /> everett PUBLIC WORKS DEPARTMI:NT � _ � ORK AUTHORIZED BY THIS PERMIT M7ST BE �•TARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DA�E PERMIT IS ISSUED�AND THEREAFTER IS TO <br /> Everett WA98201 BE DILIGENTLY PURSUFD TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CI1Y UPON ANY STOPPAGE OF WORK ON THIS <br />.:'� PROJECT OVER 90 DA1 S DURATION. <br />