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Date�lg—� � � PUEIrc Works Permil• 8 —�U,? <br /> Application For eiao�oec�.• <br /> PUBLIC WORKS PER IT P�OTatalFeeFeo S <br /> Less Aoo�Fee Pa�E S <br /> Print or Type Only � g� Ba�e�=,o�e s� <br /> N <br /> � N M <br /> � ; c�G I � � �CcY�-�n � 3 � /I�,� I9�, 'l��'a�3 d5�`lla3 <br /> Ow�r �� G � �r�Gq,qddre�s � � � ��a aa Z�P Phone <br /> � 19Y� �e2. � W �<��'� <br /> Applicant Mailing Atldress City 2ip Phone <br /> Describe Proposed W(o�rk�.��/ L� �.Y�e nc1 -fp �Y(} �-(. O� (�1rw Y.� i1 Yl l/ <br /> C , '�4 O�Yf) Y"-�la <br /> v J <br /> Project Address(if known) � � <br /> A�tech lour(4) Copies of plans for pruposed work- Draw to ecalc antl note the foilowing as appliCable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all eaisting an,f • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be peAormed 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.belore you dig.TOLL FREE NUMBER 1•800-Q24•5555. <br /> � <br /> C����2v� �r2c� � /�e�/�C..nov-c, �o O <br /> ,o.�°� ����;� ����� ^ � � � <br /> ,1 � ' <br /> /� ,���.�,� . � <br /> 0 <br />� a <br /> -/• ,� ACiiNOWLEDGEMENT OF CONDITIONS <br /> `���� W�! .,..,. 2.�uo..� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> / less the City ol Everetl Irom any and all claims for damages, costs. <br /> �����iy'W��bT^� �5�� ezpenses. or causes of acp n that may arise because of installation <br /> and maintenance of the im rovement or other right-of•way use hereto <br /> Approved for Constru n a�e applied tor and �urther agrees lo remove same upon notice Irom the <br /> City and ro replace public property damaged thereby. <br /> FINAL INSPECTION Date � S��p2,� <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTI-1JR12ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreet 180 DAYS OF DATE PERMiT �S ISSUED AND THEREAFTER IS TO <br /> Everett,WAg8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT CVER 90 DAYS DURAlION. <br />