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, <br /> Date �� PubLC WoikS Petml�• � yC <br /> BIOq.Uep1.• <br /> Appiication For <br /> PUBLIC WORKS PERMIT PubTotalFeaFee : <br /> Less Aoo�.Fee Paia s — <br /> ealance Due S �n�O <br /> Print or Type Only ��� ��z5,���)��� <br /> ��.�.Be1€,t/��aa�F �� �JGu�I J.�12. &�2�r' '1�2a� �S3 -�278� <br /> Owner Mailing Address City Zip Phone <br /> �',o.Ns �4s 4�3nv� <br /> Applicant Mailing Address Ci�y Zip Phone <br /> Describe Proposed Work ��T ✓� /�t72-M I'i �OZ /� ffJl�(� C E7N C�� ' <br /> W <br /> Proiect Address(if known) �� ~ <br /> Attach four(4)copies ot plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMiT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in eccordance with this permit and current City ot Everett Design and Construction <br /> Standards end Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � T/� F��ce s/��C d� rEi�c��¢� ��` �e nc�n���s Q <br /> ��nCC /� f�c Ci7�y /1L'c� 7�o USP 'f/iS � <br /> �rn���i'7`S�. � <br /> i <br /> O � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett from any and all claims for damages, wsls, <br /> c /' � e penses, or causes of action that may arise because of installation <br /> � � nd maintenance of the improvement or other righbohway use hereto <br /> � �/✓ LL c7 plied for an furiher agrees to remove same upon notice Irom the <br /> Approved for Constru 'on � e ity and to a pub �c roperty damaged thereby. <br /> _���Q 2��� ! �� �L 3 <br /> FINAL INSPECTIO:V Date D te <br /> Approved as C�ms;ructed ignature of Applicant <br /> WORK AUTHORIZED B ,THIS E �T MUST BE STD,FTED ITHIN <br /> PUI3LIC WORKS DEPARTMENT tgp DAYS OF DATE PERMIT I ISSUED AND THERE�FTER IS TO <br /> 32COCedarStreet BE DI�IGENT�Y PURSUED TO COMPLETION. THIS PER.d1T MAY BE <br /> Everett,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•0810 PROJECT OVER 90 DAYS DURATION. <br />