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bac � -�� S� Pu�lic Worhs Permll• �� - <br /> Application For eiaa.oeP�.. <br /> PUBLIC WORKS PERMIT Pu�licWoikaFee <br /> TMaI Fee $ <br /> LeSs Appl Fee Paid S <br /> 7� UO <br /> Print or Type Only Balance0uc s _ <br /> ( /� / I '/ / �I �+ 0.'��83�jc <br /> J'64{�LI l"JOILI��" `f'�� �I�IL��1��/P.t� �0 `H` GU�- "/ � � <br /> � �_ <br /> Owner iling Address wr City Zip hone <br /> ��c � -�pi�(��.���ert �73a G��r6u�.�✓ �� �a- ��' :0 3 c`�R��3�� <br /> Applicant Mailing Address City Z• Phone <br /> I��,1� � � <br /> Describe Propos/e�d Work I�IL . v " c���"�/ <br /> � �l�-CX �'_��P a�.�� �� �i u�a �2�� a XS�� `����..5^ � <br /> W <br /> Projed Address(if known) _ � <br /> Attach four(4)copies of p�ans for proposed work- Draw to scale and note the following as applicable: � <br /> • Pmperty Lines � Cenlerline ol street � <br /> • Outline and dimensions of all existin9 and � Indicate North <br /> proposed struct�res on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. A�I work shall be performed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> rr� Df�u'S <br /> �� � The undersigned c�vner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, costs, <br /> � �� / expenses, or causes of act� p that may arise 6ecause of installation <br /> <_-��,C .� ! /��1� � ����;.3 7 and maintena �e of e � prQveme t or olher right-ohway use hereto <br /> � ���« applied f d fu her agree�s move same upon notice Irom the <br /> Approved for Constiuction � / � � Date City and o eplac p Ijc prpp r amac�ed thereby. <br /> /� / p <br /> � �G�� �7i� � ��� �• /� � a� <br /> FI SPECTION Date � ' <br /> Approved as Constructed �gn ure of Appli 1- � Date <br /> everett PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED BY THIS P�RMIT MUST BE STNRTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DIIIGENTLY 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 />