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e{' <br /> .. . . . . . � :` <br /> DB�B /4�_�S � PUEIicWorksParmitf �`� _�/� <br /> Application For BItlp.Oeo�.+ <br /> RUBLIC WORKS PERMIT PubToteFaeFee s <br /> Leas Appt Fee Peld S <br /> Print or Type Only BalenceDua S 7-'T y=S <br /> ToE �iG.c%a�.4,e� S�BoB—Et�E-�c:f+�EE.�/ �E.e� c%. 9azos� �59-giof� <br /> Owner Mai4ing Address City Zip Phone <br /> Applicanl Mailing Address City Zip Phone <br /> Describe Proposed Work ��aST�PUGT l�,eA�i[ldG-5 FaG�ciriE..f� <br /> W <br /> Project Address(if known) �✓�/�T/� �ll_S�U— ✓ . . .c/ Gc.J4 � , � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures 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 calis 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 o(Everett Design and Construction <br /> Standards and Specificationa <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> P, T 6'E Cd.r:.ST,E'urEO PE'•c? fl f�i�i�ovE.v � �cd N�S O <br /> ,04T6G� /t�-/-yS. <br /> � <br /> � <br /> O <br /> a <br /> ACKNGWLEDGEMENT 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 installation <br /> .��!/��� �� J-� �5- and maintenance.of the improvement or other righbof-way use hereto <br /> -��� applied for and furthei �yrees to remove same upor. notice from the <br /> Approved fot onstr tion Date City and to replace public property damaged the;eby. <br /> � � l ��g7 ""1 ;j�� ' --�-iT--> :�/�/�s <br /> FINALINSPE TION Date � � ��ii //��./�stfl��'�- <br /> Approved as Constructed Signatore"of�l�a�' Date <br /> everett PUBLIC WORKS DEPARTMENT WORf�AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98207 BE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />