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_. 86 86 - 33� <br /> Punbc Woikf Parmlt• <br /> Det6 emo.oea�.• <br /> Application For _— <br /> PUBLIC WORKS PERMIT PuD1lcWorMSFee <br /> To1a1 Fee s <br /> less n0o�.Fee Peld s `' <br /> Belanco Oue S� LnA'P6� <br /> Print or Type Only <br /> Rab r� (i A )�t�� ac .5�120 �9tti /�� dU E' D�a�ys�� ll� �iSz7� �.s"�/- 7 . <br /> Uv:ner Mailmg Address <br /> CitY Zip Phone <br /> ,5(�(�1G 0.S bo ,�e ���Y ZiP Phone <br /> Applicent Mailing Address <br /> � ' N �o�' t rash „�h;lF <br /> Describe Proposed Work � <br /> � c,��tmn-Ler I �� o.�� e�-�---��or��r��� <br /> t I� O� Cr� � � U F � Q� <br /> L <br /> W <br /> Projecl Address(il known) � � � � t tl I� �J� ��� � <br /> � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> � Property Lines � Centerline ol street <br /> • Outiine and dimensions of all ezisting and • Indicate Norfh <br /> proposad siructures on the lot • Show any Proposed grading changes <br /> • Existing and proposed utilitles <br /> • 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 of Everett Design and Construction <br /> Standards end Specitications. � <br /> 3. Call Location Underqround Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> ��� 1 c�z t �" � 2 c u l,v ( .�AN �� A i � <br /> � 4 � �'�: ,5 t �� � � .�--- � <br /> � � N <br /> � <br /> / /; <br /> a <br /> � Y'�C . <br /> U ��, ACKNOWLEDGEMENTOFCONDITIONS <br /> �D . �'� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, costs. <br /> er.penses, or causes of action thal inay arise because of installation <br /> J" �� "� SJ /� and maintenance ol the imUrovement or other righPobway use hereto <br /> - `�idivo�'y� �j1 86 applied tor and further agrees lo remove same upon nolice from the <br /> kpproved tor Con �v ction Date City and to replace public property damaged ihereby. <br /> �^�l� ��O �� b�llla�' ��,m,�'�t ,p -�= 86 <br /> FINAL INSPECTION .. Date � Date i <br /> Signature o(Appli n <br /> Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 D�'IS OF DATE PERMIT IS ISSUED AND 1HEREAFTER IS TO <br /> � 3?00 Cedar Street BE DILIGCNTLY PURSUC.D TO COMPLETION. THIS PERMIi MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UFON ANY STOPPAGE OF WORK ON THIS <br /> Phone� 259-8815 PROJECT OVER 90 DAYS DURAIION. <br />