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- -- - __� <br /> -- ------ - -- ---- � <br /> --- - - -(�-,---------- _-___ - .. <br /> flov,�,�x _. p <br /> DBte 3 I-�S� ... PUEIm Wods Permll• /S �l�� <br /> - Biea.Deoi-• <br /> Application For . I <br /> � PUBLIC WORKS PERMIT P°°°°W°",F°° s <br /> I � Talal Fee <br /> �-.� �(, rl� , \1���\! � ��j LessAo0l.FeePaias� <br /> "�I !�.�-I � v v �/� .. <br /> � Balance Due S ^'T� <br /> Print or Type Only ' � ' <br /> � ,_ dG'<-3z��fo/7e 3/ I <br /> i�� � � "��j�� ' '�jc', <br /> ��. <;i� � _ <br /> Owner Mailing Address Ci1y � Zip Phone <br /> I <br /> � I �D 5 (c.y.,��VI�CC)�; ��< G�`�2�� � <br /> � <br /> Applicant Maiting Address City Lp Phone � <br /> i <br /> � '� - --�1.� � ��l <br /> � � <br /> Describe Proposed Work ' / - � <br /> �--- � / -- � —` <br /> i �� �L�il ( . <br /> W <br /> Prolect Address(if known) �����----- � I <br /> I <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the tollowing as applicable: � j <br /> � • Property Lines • Centerline of street . � I <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes i <br /> • Existing and proposed utilities • Show measurements M I <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMITCONDITIONS �('� 1 <br /> 1.Ail cells for inspection shall be rttHde 24 hrs.in advance•phone 259•8810. � I <br /> 2.All work shell he performed in accordance with this permit and currenl City of Everelt Design and Construction <br /> Standards and Speciltcations. <br /> 3.Call Location Underground Service 48 hrs.before yau dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 7 / v(/ -�C°s ��-� T"o G'c' �C%��;,�f�c: in 7f�' �v(.'%"iL O <br /> ,�J/f - of rr/�y, <br /> - r If Thu� c;fy' S/o�-ld �':-� r r,�:��r �v u� f��s � <br /> I _ - !� �, lP /�� ✓� 7`0 (uur.E On �it te. :,�_�, � <br /> .P�y/f � � � a < .. " � <br /> c ' <br /> �>r o�/•P �' c.7%l.�cs C�.f/;� f/�e i('�6f� uf= t</a % <br /> -� , s�,�� h,�. v;,S/�a.,<,6!c a <br /> //�='n DC./�;c���OPL/!c i,;� �,. <br /> ' f/P ��:ce zf ��.s r.r`i��„ce <br /> i�/- /"Ci,.ovin5 � /Cf�Cyr;n, . . . <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett from any and all cleims for damages, costs, <br /> �-s`�.-� . � ezpenses, or causes of action that may ari9e because of installation <br /> � ,��� ��� and maintenance ol the improveme�l or olher right•of-way use hereto <br /> /�v�-- i-- � �G��� applied for and further agrees to remove same upon notice from the I <br /> Ap oved foi 06n uction� a�e City and to replace public properry damaged ihereby. <br /> ���-�`°�� � � � �� - � . �- <br /> � ' , <br /> _ , , , O' , , J <br /> • � � �-�. - , <br /> FINAL INSPECTION Date /� � � _ ; ��_ .- , Date I <br /> Approved as Constructed Signature ol ApplicaN <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN I <br /> �A�� PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 CedarStreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet4 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PAOJECT OVER 90 DAYS DURATION. <br /> i I <br />