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'. ' p$t@ / p!/ / >- Publlc Worke Permit e / / '�� ' � <br /> �� Application For � eie9.ono�.• , <br /> Y ! <br /> f� PUBLIC WORKS PER111�T PUCIicWarkaFee <br /> To�e�Faa a <br /> �� � Lesa AOP�Fee Paid S � <br /> � � BelanceDua s ��OO <br /> a Print or Type Only ¢ � G <br /> :: � o o ���(.31.}'L-01� <br /> ::i c.i ni , <br /> � <br /> �.» at <br /> � ?���chne.l �. �eacAck �g�1 �o�r�� �r. Q�3 aS�i�U$3 <br /> Owner Mai4ing Address P '� � f�lty, Zip Phone <br /> � .�-i � 7 4, <br /> � ,M���hQe I 5� t�ce�c1� 4�0- � ��s+ ur. qa203 a-S�-�0�3 <br /> � Applicant Meiling Address City Zip Phone . <br /> � , <br /> Describe Proposed Work � e'� � � W 1� `4"x � <br /> � '�Y'►�►��au,. �Ar�1J'�e..-12 �o .�'Qq� �o S�Y��t RtJ� TD <br /> ` �t r '► vyi�h , e <br /> � .pj-�' W <br /> � Pro�ect Addresa Qf known) � ��-`� � !� <br /> i <br /> � Attech four(4)coples of plans for proposed work- Draw to scele and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> •Outline end dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> � • Exiating end proposed utilities • Show measurements � �� <br /> i DO NOT WRITE BELOW THI5 LINE O �� <br /> � PERMITCONDITIONS } <br /> � 5.All calls tor Inepection shall be made 24 hrs.in edvance•phone 258-881 O. � $ <br /> 2.All work shell be performed in eccordance with this permit and cunent City�Everett Design and Construction <br /> Standerda and Specitications <br /> � 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�4245555. � �. <br /> � y �`�b'°v -�� �. i" �,P � .�� � .��� � ; <br /> � ,�,�,t �..� �� ��.,. ��� d� d�� . � ; <br /> � <br /> � 5 ��e� �'.�.� �.� �� �� �-t.� �.� N ; <br /> � �°� �� � ; <br /> � <br /> a <br /> - � ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm� <br /> Iess the City of Everett from any and all claims tor damages, costs, <br /> � ' `�/ �� �Q�/ expenses, or causes of action that may arise becausa of installation <br /> • �]I�( and maintenance of the improvement or other right-of-way use hereto <br /> '� applied for and further agrees to remove same upon notice from the <br /> Approved fo�Conslr �ti�of ate City and to replace public/p/�r yerty damaged there6y. <br /> .. _--''✓ " ��.. �-/1 "/rL / // <br /> � FINAL INSPECTION Date ���v`�'�J�d 1 - �Q��S�`� I <br /> Approved as Constructed S�i nature of Applicant Date <br /> PUBLICWORKSDEPARTMEN? WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �� � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> � Phone:259•8810 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />