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�ate l b -22 -9� PUEhc Works Permlt• 9 `f 8�' � <br /> Application For eieo.oeo��• <br /> PUBLIC WORKS PERMIT PuOhtWo�ksFee <br /> Total Fee s <br />� Less Aoo�Fee Pe�O S n <br />� BalanceDue S ��/a- <br /> Print or Type Only <br />, /�1��c1c�t2.� � Q�'�'�^y . �QUZO lJ. G��F�t �►^- �ue�-ef� y8'.,2(1_� 3S3— �f87� <br />� Owner Mailing Address City Zip Phone <br /> .Sc(,vH �. <br /> Applicant Mailing Address City Zip Phoiie <br /> DescribeProposedWork Ii' ����� � �J1� ��G�C-� Lti '�- ��I`�N �US'�-G�'7e"2� <br /> � �/4�i-�"Or-Cclk✓1 <br /> l <br /> W <br /> �U.2 � Gc� - �� �� j-, � <br /> Project Address(if known) � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note tne following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspectton shail be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed tn accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificationa <br /> 3.Call Locatlon Underground Service 48 hrs.befare you dig.TOLL FREE NUMBER 1-800�424-5555. � <br /> � n/ �is�.�¢ �t.� 6.L /�`.P�'^a_7/lcy' A��tal C7w!"it�/Y..r O <br /> ✓„p� � .��1�../ /G�t�j !'t[cd �o Gcac �o �4c�Rt.�y . <br /> �p.ti+"t2 s • �. <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less tha Gty ol Everett irom any and all claims for darnages, costs. <br /> ezpenses, or causes of action that may arise bec2use of installation <br /> �� �� _ and maintenance of the improvement or other right-of•way use hereto <br /> applied for and turther agrees to remove same upon notice trom the <br /> Appro d lor Coo t' n ���e City and to replace public property damaged ihereby. <br /> ti ���\ � 'cq� � T /7 <br /> FINAL INSPECTION Date �� `�'�"`�z�'� " ' "`-� /D "—'� ��� <br /> Approved as Constructed Signature of Applicant Date <br /> �A�� PUBLIC WORKS�EPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THI£ PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE(;ITY UPON ANY STOPPAGE OF V.'ORK ON THIS <br /> Phone:259•8870 PROJECT OVER 90 DAYS DURATION. <br />