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_� <br /> �1 <br /> I� <br /> Date.���/^` Pu�llc WarFs Per 1� _ <br /> AFP�ication For [iltlB��epL����51 <br /> PUBLIC VVORKS PEI�MIT PubTalalFeeF¢e � <br /> Lass AppL Fea PaiO g <br /> Balmce Dua $ <br /> Print or Type Only <br /> ��e� � `'d� c�.�„�. y�s� �..��c...�-�-... _ � <br /> 0 <br /> Owner Mailing Address City Zip Phone .-. <br /> c'� <br /> � �O'�.� m <br /> Applicant Mailing Address City Zip Phone � "" <br /> --1 "� <br /> '�FC/ � �' �'� C� /v�/ N <br /> Describe Proposed Work C-2 hw / �, m <br /> 0 <br /> co <br /> m o <br /> c� <br /> O 3 <br /> � m <br /> _ -�i <br /> m <br /> Project Address(if known) ��� � A = <br /> Attach tour(4)copies of plans for proposed work• Craw to sr e and note the lollowing as applicable: � � _ <br /> • Property Lines • Centerlinz ol street � -�-1 v� <br /> • Outline and dimensions of all existing and • Indicate North "� -q <br /> p•oposed structures on the lol • Show any proposed grading changes o D <br /> O Existing and proposed utilities • Show measuremenis � <br /> -a m <br /> x <br /> DO NOT WRITE BELOW TIiIG LINE O �^H <br /> PERMIT CONDITIONS <br /> � m <br /> 7. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. <br /> 2. All work shall be per(ormed in accordance with this permit and current City ot Everett Design and Con�truction � m � <br /> Standards and Specificetions. .-.i r <br /> 3. Call location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � • m <br /> a <br /> A <br /> O � <br /> 2 <br /> a <br /> � �//'Gi� ��i���r,F�� t��,��;�.T- �E-���,;e'�./� � <br /> / � _ <br /> ,> � <br /> ;� � � 7—zz 8S" �, <br /> y � <br /> Z <br /> 0 <br /> � <br /> � � <br /> m <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apPlicant hereby agrees to hold and save harm� <br /> less the Ciry ot Everett Irom any and all claims for damages, costs, <br /> expenses, or �auses of action that may arise because of installation <br /> and maintenance of the improvement or other right-oFway use herelo <br /> applied for and lurthe� agrees to remove same upon notice irom the <br /> Approved tor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature of Applicant Date <br /> evcrctt PUBLIC WORKS DEPAFTMENT WORK AUTHORIZED BY THIS PEPMIT MUST BE STARTED WlThil� <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DII.IGENTLY PURSUED TO COMPLE710N.THIS PERMIT MAY BE <br /> Phone: 25&881 S CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />