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:a <br /> ,.r, <br /> . _ ... .__"'_ ._. . .. . ... . _ . . <br /> . N aq� �•� _. <br /> r- ; ._ 's�t, ��„ ,! <br /> ��ace� �J' ., ,, <br /> �� PuElic Worke Parmlt• "� + <br /> Application For eiao.oao�,s "' aZ <br /> PUBLIC WORKS PERMIT P°°�;°W��k,Fea <br /> r��a�Fee s !'oc� �' <br /> �asn apo�Feo ve�e S � <br /> � <br /> Print or Type Only ea�a��e o�, s ��� " <br /> •1� 'r � �3/� <br /> m�'- a� ��,� ,� a.s-�- €io <br /> wner Mailing Address City Zip Phone <br /> � i i o i.,� ��.�%� ��Q s��r.�' �i t,.��� �/,S -r�i� <br /> �Applican Mailing Address City Zip phone <br /> T`�s-��-v �� - (Yo-� - /l�2'`�S �''� ��-PQ,�.�. ysY�- o��i � i)a,�. <br /> Dsscribe Proposed Work <br /> / � c-� � 9� <br /> W <br /> � � -��. �' `'�, H <br /> Project Address if known <br /> Attech four(41 r.opies of plans for proposed work- Uraw to scale and note the followiny as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor 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 of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � _ <br /> � ,��' �L�9� v>ft��� ,-��y_�� O <br /> � <br /> � <br /> O <br /> a <br /> F�CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less the City of Everett from any and all claims for damages, costs, <br /> �� expenses, or causes of action that may arise because of instaltation <br /> ��7 9 and maintenance of the improvement er other righbof-way use hereto <br /> �" � applied for and further agrees to remove same upon notice from the <br /> p roved fo Con c ' Date City and to replac public property damaged thereby. <br /> I ! � � 2 <br /> FINAL �NSP TION Date <br /> Approved as Constructe�' ign ur of Applicant . Date <br /> PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED \VITHIN <br /> e��erett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY °URSUE[� TO COMPLETIOiJ.THIS PERMIT MAY BE <br /> Everett, WA 98201 CANCFLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 ppOJECT OVER 90 DAYS OURATION. <br />