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� <br /> r �' <br /> �8te1J..1�L.�C/.." ! ^ ^. PublleWorktPlr�� /� �� <br /> I <br /> ApplltetlOn Fo� BIEp.Dapc• <br /> PUBLIC WORKS PERMIT P�DIIeWork�Fo -- <br /> Tot�l Fss : <br /> Laes ApP�Fae P�iE d <br /> Bal�nce Due 6 <br /> Pr[nt or Type Only <br /> �'��,e�� E� ,�lr��� �/�o� �o��,�7' �J'�e �o�`" �s-� - � as� <br /> Owner Meiling Address City Zip Phone Z <br /> 0 <br /> �� � � <br /> � <br /> Applkent Mailing Address City Zip Phone m <br /> �� .. .r <br /> Describe Proposed Work � � <br /> ... .-.� <br /> in x <br /> ' <br /> m <br /> � m� <br /> o� <br /> Project Addresa(it known) � � _� <br /> m <br /> Attach four(4)copies of plana for proposed work- Draw to scale and note the following as applicable: � "" <br /> o z <br /> • Property Lines • Centerline of street � . <br /> • Outline and dimenaiona ol all existing and • Indicate North r'— i <br /> propoaed structures on ihe lot • Show any proposed grading changes ..`".� N <br /> • Ezisting and proposed utllitiea • Shovi measurements � < <br /> o� <br /> DO NOT WRITE BELOW THIS LINE <br /> � <br /> PERMIT CONDITIONS m y . <br /> t. All calls for Inspection shall be mede 24 hrs. in advance- phone 259•8815. � o <br /> 2. All work shell be peAormed in accordance with this permit and current City of Everetl Design and Construction n m <br /> Standarda end Specifications <br /> 3. Call Locetion Underground Service 48 hra before you dig.TOLL FREE NUMBER 1�BOO-�M124-5555. � m� <br /> �m <br /> O p <br /> y � <br /> e� �7 = <br /> � w P H -� <br /> _ <br /> U � /f�ur�� � vi <br /> �- � O Z <br /> � � �y o <br /> g' �`� / a m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneUapplicant horeby agrees to hold and save harm- <br /> � less the City of Everett irom any and all claims for damages, costs, <br /> expense�, or causes of action thal may arisa because of installation <br /> and maintenance of the improvement or other right•of•way use hereto <br /> applied for and further agrees to remove same upon notice irom the <br /> Appreved for Construction �a�e City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ot Applicant Date <br /> everett PUBLIC WORKS DEPAfiTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PEIiM1T IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ce4er Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITI'UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 50 DAVS DURATION. <br /> I <br />