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r ' <br /> oate�[�.�'q P��o�,��;,,��PA,m��. RI— /�S_ <br /> Application For Bi�g Dept•__�t_�U�6 .__.. <br /> PUBLIC WORKS PERMI'T P�°;o,wF��F�� g ----- <br /> �ess nnni Fee Paro �___^ <br /> Balanco 0w S �`V�— <br /> Print or Type Only <br /> ��d7d@�t1,f� cY`��`� -�'i�m D.Q G[J /j'�N�-,/��r� 9��7S 353-660� <br /> Owner Mailing �tldress City Zip Phone <br /> 1B JQ!�'�- — <br /> Applicant Mading Address City Zip Phone <br /> ( � <br /> Des.:�IbePioposedWork /Jpu/_s��P dt ��Y �DML t-�t aa �VPrn�Pnn ��� <br /> Pro�ect Address(if knoNN �v�' r ��L�FST �l�� U�� � <br /> � <br /> Attach four�4) copies ol plans for proposed work� Draw to scale and note the following as appliwble: � <br /> • Property Lines • Centerline of sireet � �, <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Ezis�ing and proposed utilities � Show measuremenis � , <br /> I <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � ! <br /> 2.All work shall be performed in accordance with!his permit and wrrent City of Ever�•��Design and Consiruction <br /> Standards and SF'cificat��ns. <br /> 3.Call Location Underground�erv�ce 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> Y C�a,f��C �o�-� �s[!✓, �Or�c'�L�°i% CCu=G�-ul�1 .CCn2l.�='t�i O <br /> �G�-GciG�GJ . <br /> v/ � <br /> � <br /> O <br /> a <br /> s,e ACKNOWLEDGEMENT OF CONDITICNS <br /> Y� <br /> - S The undersiyned owner/applicant hereby agrees lo hold and save harm� <br /> less Ihe Ciry ol Everetl Irom any and ail claims for damages, cosls. <br /> �/����� �///� eapenses, or cause5 of action that may arise because ol installation <br /> and maintenance of the improvement or other nght�ohway use heretc <br /> applied lor and further ac�rees to remove same upon notice Irom the <br /> Approved for Construcf on ate Citp an/d�to replace public pr erry dama3ed thereby. <br /> ,�,,��f�l�/ 3-�-yo /f� /;� / � <br /> FINAL INSPECTION Date L1�'��__-�,���� <br /> Approved as Constructed Signature ol AppliCant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everelt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE P�fiMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street 9E DILIGEf�TLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 99201 CANCELLED BY fHE CtTY UPON ANY S70PPAGE OF WORk ON 7HIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />