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r �` <br /> , :� r.� - <br /> � ,, <br /> � <br /> � <br /> r <br /> DetB�s � a�eu�wo�k.P n. $4 1 SL <br /> AppliCetion FOt eiau.oeai.e 3 �O�_ <br /> PUBLIC WORKS PERMIT �u�TaalFeeFee S .,.o.�,o <br /> Lem Aop�Fae Peitl S <br /> � <br /> Bd�nce Due S ��'� � . <br /> Print or Type Only <br /> �r�n�� �o� G /�� �.�o��L A�e �uei�e7f' 48�03 �s� -.36�7 <br /> Owner Mailing Addrass City Zip Phone <br /> �erei,�� �:lt �3�1h �'�P�eTf-�-o � �ue�z�e�" 9�.1d/ c�?�i�-yl�/ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 2�' �' - �/ v / <br /> W <br /> Pro�ect Address(il known) � d � �� � <br /> Attech tour(4)copies of plans lor proposed work- Draw to scale and note lhe lollowing as apP��cable: � <br /> • Properry Lines • Centedine ol street � <br /> � Outiine and dimensions of all existing and ! Indicate North <br /> proposed structures on lhe lot • �how any proposed grading changes <br /> � Existing and proposed utilities • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 7. All calls for inspeclion shall he made 24 hrs in advanco• phont 259•881 5. � <br /> 2. AII work shall be peAormed in accordance with lhis permit and cu�rent City of Everett Design and Co�struction <br /> Standurds and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FPEE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to ho�d and seve harm• <br /> less ihe City of Everett from any and all claims for damages, costs, <br /> expenses, or ceuses ol action that may arise because of installation <br /> `–��r��!� f=�J: ��/ and maintenance ol the improvement or other righDof-way use hereto <br /> � ��. .� / <br /> applied for and lurther agrees lo remove same upon notice rom e <br /> A�oved lor Conslruction �a�e� City and to replace public properry demaged lhereby. <br /> �j�%���� 7 -�r- �� �� ?irc, �,�-�,•�� .5/s21�'f <br /> �.. FINAL INSPECTION a�e —�' Date <br /> Approved as Consiructed Signature ol Applicant <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AIJD THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS P[RMIT MAY BE <br /> Everetl,WA 98207 CANCELLED F3Y 7HE CITY UPON ANY STOPPAGE OF WORK O'I THIS <br /> Phone: 259•8815 PROJECT OVER 50 DAYS DURATION. <br /> � � <br />