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� <br /> _ ,,,�,y, <br /> �8te_-_- . PuC1�cWa/kaPerm�q� _ _ ' <br /> AppliCeliOn FOr emo�Deo�.• <br /> PUBLIC WORKS PERMIT v�aaworkaF�� ,/ iy 'r-� <br /> Ta1el Fee s=� ' <br /> Les!Appl.Fee PaiE .S <br /> Print or Type Only BaianceDue s �"' <br /> :}.._,. '_. � . . � '' <br /> '���;,�,�c _ �fl/1....'�.( - +'�'j� :� - �� ='�,� -- ��. �.. .� - 1j� -- •% <br /> Owner Mailing Address � City Zip Phone <br /> /��. .. i� _ /.:. . �'�.'� f�J . ,<� _ iL,�� ( ._ -r� .l) N�). �. <br /> Aop�icant � Mailing Address City Zip Phone <br /> Describe Proposed Work � �' '<� ��� `� " -,� � �� `-_ <br /> � <br /> '!: ' - ' <br /> f ro�ect Address(il known) -'�` ��t � <br /> -� "i /:_._ '.�'� i �-�,�" .�., <br /> A�lach four(4) copies of plans lor proposed work- Draw to scale and nole the lollowing as applicable: � <br /> • Property Lines • Centerline of slreel � <br /> • Outline and dimension,- ol a�l existing and • Indicate North <br /> proposed structures on th�3 lot • Show any proposed�rading changes <br /> • Existing and proposed util�ties � 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 shal�be perlormed in accordance with this permit and current City ol Everet' Design and Construction <br /> Slandards and Specilicationa <br /> 3. Call Locutlon Underground Service 4B hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ) µ � <br /> � �^=�'\^ �� `l;`%��, ' %� �� O <br /> i' <br /> � ���'LS���7-�/ �'vrtJ/�%G y.r� = , ,` , , � � <br /> � <br /> �.' �' . ,. . ., �,5� ;c" �' �jL ' 1 ,�''� ,_ � .. � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned owner/applicant hereby agrees to hold and save harm• <br /> less the City ol Everett irom any and all claims lor damages, costs, <br /> - � -�� � � � . expenses, or causes of action thal may arise because of insta�lation <br /> _ - _ � \_��-.,. � and maintenance of the improvement or �ther righPoFway use hereto <br /> � �' - ! applied lor and further agrees to remove same upon notice irom the <br /> roved lor Construction - Date City and to replace public properry damaged thereby. <br /> i <br /> L INSPECTION Date � "' - � <br /> roved as Consiructed Signature of Applicant Date <br /> eret[ PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS�PERMIT MUST BE STARTED WITHIN <br /> 320J Cedar Sireet 180 DAYS O� DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE �ILIGEN7LY PURSUED TO COMPLETION. 7H15 PERMIT �AAY BE <br /> Phone: 259-8815 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />