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__� <br /> '_ � <br /> �8�e�� Pu�lic Wo�ks Permll• -�"-�'�� �'s�— <br /> Appllcetion Fo� Bldp.Dept• �y/T� /G✓� <br /> PUBLIC WORKS PERMIT Pue7owFueFa� s <br /> Le�s ADVI Fee Peltl S -f <br /> Belcnce Due S `���l� <br /> Print or Type Only ��5�� <br /> o�,o� t�fl��. �I�Cc��Q e a�3 � Ncti� �� ou ..S�e.a- ��/ '��y- 099 y <br /> Ownar Meiling Address City Zip Phone <br /> z <br /> �flht e. -�-� <br /> Applicent Mailing Address City Zip Phone m <br /> DescribeProposedWork ���� ����? '--""' <br /> � � <br /> .-� --� <br /> �n x <br /> 0 <br /> m <br /> � co <br /> mo <br /> n <br /> — -� c <br /> Pro�ect Address(il known) `'��' `j��'� � —�j Z <br /> Attach four(4)copies of plans lor proposed work• Dra +to scale ard note the following as applicable: �� m � <br /> � Property Lines � Centerline of streel /A � z <br /> • Outline and dimensions of all existing and • Indicate North V� y � <br /> proposed structures on the lot • Show any proposed grading changes r x <br /> • Existing and proposed utilities • Show measurements � �N <br /> � � <br /> DO NOT WRITE BELOW THIS LINE O <br /> O 3 <br /> PERMIT CONDITIONS 'a m <br /> 1. All calls for inspection shail be made 24 hrs. in advance- phone 259•881 5. . <br /> � m �-+ <br /> 2. All work shall be partormeA in accordance wi+t� this permit and current Cily ot Everett Design and Conslruclion p � <br /> Standards and Speci�ications. � m <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � 3 N <br /> - � CCFOy OF O/2T i� <br /> .STicC'ET jc� B6 ���T ��� O � m <br /> n <br /> !�Eld.��S .1> AcL 7/-1CS 1 U.G1i.�'C^ Cc�NS Y.zc�C:io.✓. � <br /> -i <br /> � <br /> a <br /> z <br /> � � <br /> � <br /> O � <br /> 0 <br /> a -' <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF C:JNDITIONS <br /> The undersigaed owner/applicant hcreby agrees to hold and save harm- <br /> - less the City ol Everett from any and all claims for dama9es, costs, <br /> expenses, or causes of action that may arise because ol installation <br /> �._}�`�� �'c L /_y �/�� 3� and maintenance of the improvemant or other right-of-way use hereto <br /> /� � � applied lor and lurther grees remove same upon notice Irom the <br /> Approve r C�struction Date Cit a d to replace p li pro y damaged thereby. <br /> ? d � � A <br /> FINAL INSPECTION � ,� 'C,Date � � J S 23 't <br /> Approveu es Consiruct Sign ture f Applican Date <br /> everett PUBLIC WORKS DEP RTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAFlTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7fiIS <br /> Phone: 259•8015 PROJECT OVER 50 DAYS DURATION. <br />