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Q ' ` � � <br /> Date� / v�oi��wo,hsaa,m�� FJ`I �9'C�`7� <br /> Application For BItl9 Oepl.� _��_— ,/�7+ Lj_.�__ <br /> PUBLIG WORKS PERMIT P°°��°W°,�sF�° - ------ <br /> Total Fec §— � <br /> less>p01 Fee Paia $_ <br /> e,i,,:��:�o�� S GLe'�G <br /> Print or Type Only <br /> `����, i � ��� .�� �� �� �'��.��ff qs��� � � 3�-��7� <br /> Owner Mai{ing Atldress City 2ip Phone <br /> k « <br /> Applicant Mailing Address City Zip Phone <br /> Descnbe Proposed Work ��i� <br /> � At \ W <br /> ProjectAddress�ifknowr,) jJ` ��CJ �^I( F,-I��(A���"�`J � <br /> Attach four(4) copies ol plans tor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • OuUine and dimensions ol all existing a�d � Indicate Norih <br /> proposed structures on the lol • Show any proposed grading changes <br /> � Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BE�OW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AII calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.Atl work shall be peAormed in accordance with tliis permit and current City of Everett Desiyn and Construction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 4B hrs.helore you dig.TOLL FREE NUMBER 1�800-424•5555. � <br /> "i, ���t'� `CCt,�.'t- '�T% �41c���:>�` T�ltc-f-ixt�.., cvi �L\ t�ihliG. �--1oYF: O <br /> � n s(}c c_'l-or �r'. c r -�-o S-{u r�� �s cwe v— c�+ti:s-l-r�-�-1-'�n, . <br /> �. �n S't���� >i..u1-G..S � �lln'�Q.v� �. !i'�-� �,rri�n.�q�. `.:c-rYtG:rk4 �r-{�:�..� � <br /> V �Sr.�: -1 1�lnd- .,..�1/,- t�,, � 1d,�„�r_n�_ O <br /> l�� �/Wf_ �r�Uz.w-n�� <br /> a <br /> /� 9(;KNGWLEDGEMENT OF CONDITIONS <br /> ' l� Tho undersigned owner/applicant hereby agrees to hold and save harm� <br /> - less Ihe Cily ol Everett irom any and all claims lor tlamages, costs, <br /> �—, ezpenses. or causes of action that may arise 6ecause ol installation <br /> ���� 1/11 ` 1��� r�+� _� - q.-1 and maintenance of ihe improvement or other right-of-v�ay use hereto <br /> � � � appli lor and lurlher ac�rees to remove same upon nolice Irom the <br /> Approved fo�Con r ion Date City an lo replace pubhc properry damagetl thereby. <br /> ���� �/� �o � <br /> FINAL INSPECTION Date �� 30 <br /> Approved as Constructed Sign, e of Applicant Da e <br /> everett PUBUC6VORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> FROJECT OVER 90 DAYS DURATION. <br />