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� .. <br /> �8te�O V ^. � Poplm Worke Pe�mil• <br /> T� <br /> Applicalion For Biap Oeci a�� <br /> PUBLIC WORKS PERMIT P��to�eFeeFee s <br /> Leaf AO'�L Fae Pald S _ <br /> Balence Dua S <br /> int or Type Only <br /> �" c :. �i•,+ yrr3o �/�� /l�,.r f��Tl 5;'c�.�' �S.Z -7/.Z� <br /> Owner Mailing A� ess City Zip Phone <br /> �> �� �7 � � -��1- �.7 /�` 9�'��'3� 3'3v-�c�Y <br /> Applicint h7ailing Address City Zip Phone <br /> Describe Proposed Work /S�t�J`-� /�'i'��X/r/ ?��'�`� _— <br /> W <br /> �roler.t Address lif know�� y��3G ���h' � � <br /> Attach four(4)copies of plans lor proposed work• Draw to scale and note the lollowin�as applicable: � <br /> • Propert�:Lines � Centerline of street � <br /> • Outline an;dimensions ol all existing and • Indicate North <br /> proposed str�-tures on the lot • ShoN any proposed gradir�g changes <br /> • Existing and pro,�osed utilities • Shew measurements <br /> �i= DO NOT W91TE BL-LOW THIS LWE � li <br /> PERMIT CONDITIONS O � <br /> i. All calls for inspection shall be made 24 hrs. in advance- ohone 259•881 5. � �� <br /> 2. All work shall be performed in accordance with this permd and current Ciry of Everetl Design and Construction <br /> Standards and Specifica�ions. <br /> 3. Gali Location Un�erground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> �UBfiC G�/o�,Es' .�E�r,�ii �/aT .c.'E��..�c.p O <br /> � Z/8� � <br /> � � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to ho�d and seve harm- <br /> � less the City ol Everett trom any and all cleims for d�mages, costs, <br /> ezpenses, or causes of action that may arise because of instailation <br /> and maiNenance of the improvement or other right-obway use hereto <br /> applied for and further agrees to remove seme upon notice irom the <br /> Approved for Construction Date City and b replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WnRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder S�reet E3E DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br /> Everett,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATION. <br />