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r: �, <br /> Date -- Z ? Public Works Permit# / i 73 <br /> Application For~J Bldg.Dept.# <br /> PUBLIC W O R KSal Fee <br /> I PERMIT Public Works Fee $ <br /> LI Less Appl.Fee Paid $ <br /> Only <br /> $ �..- <br /> Print or Type ` r Balance Due �✓ <br /> Y ,- d <br /> 4, <br /> Aiilal‘ :SGrK �� �Df I � 1�. �v� Gv_Pt� Tif 7 DGC) L �2 � tt � <br /> Owner Mailing Ad {lessp 3 City Zip Phone <br /> / J t v'"' ..i 4/rl - 9/ // (aff.e C 4 �'- U ;.'e G"✓ `rf d 1 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ," 1 i I^ 1,. ,,,, ,, 4z, ".. i. i j„ 7" o' c7 `�e'r'cv f't-vt <br /> rcff/IMI /fQ/4af4Its 5- <br /> W <br /> Project Address(if known) /-/(.G ( 1 (ul 1e5e -"4✓e 4. ✓e iti7L11.111 <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: NEN <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and •• Indicate North CO <br /> proposed structures on the lot •• Show any proposed grading changes <br /> • Existing and proposed utilities •• Show measurements <br /> CD <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 4.4...„ <br /> lio, <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> ,„vo ,,, <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> 1" p, r <br /> 7, Fc�Irt Iv\ e tac tt vc r$.5y.. ,c,i-, 0 <br /> r <br /> rff I— <br /> Cl) <br /> 1... <br /> f-----144‘11 <br /> }uvse O <br /> Om <br /> -C�011e5f A u C <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> ' less the City of Everett from any and all claims for damages, costs, <br /> ��- -- - - may;.- ., , expenses, or causes of action that may arise because of installation <br /> -�- P_.. <br /> - nd maintenance of the improvement or other right-of-way use hereto <br /> -` _�✓ <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Constructfion -- ate City and to replace public propert damaged thereby. <br /> FINAL INSPECTION Date ��1 1 fz.. <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT 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. THIS PERMIT MAY <br /> Everett,WA 98201 <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 <br /> PROJECT OVER 90 DAYS DURATION. <br />