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, . . . ' . - .. . � . .. � . . .f.`-0v . ' S',� . . . ... i :w . .;�.t:�,{m <br /> Date�C.Ll�I� �� � a,�eu�wo,wsvamw• 8` � 3 <br /> oiao oaoi.• �-�� <br /> Applic2tion For I <br /> PUBLIC WO�+KS PERMIT PubOcWorkSFee s — <br /> iolal Fee <br /> . Less nooi.Fee Pam S �O 00 <br /> Balance Due S <br /> Print or Type Only <br /> �� I <br /> , <br /> �j . � � �131 `-L��UI')1�1� C�lt�f'E'�1" �?7��� <br /> Owner <br /> Mailiog Address Cdy Zip Phone <br /> <�-������ <�n����`— �l�l "1 I�,��� ��-- � �. _�,����'�;���� .�y-���z. <br /> �pplicant <br /> Mailing Address City Lp Phone i <br /> � /r�t, l <br /> Describe Proposed Work ��r�r��1� <br /> I W <br /> Project Adtlress(if known) � ��-�-�'--" � <br /> Attach lour(4)copies of Pians tor proposed work• Draw to scale and note lhe following as applicable: � <br /> - • Property Lines • Centerline of street � <br /> • Outline and dimensions ot all e■i,ting and • Indicate North <br /> � proposed structures on the lot • Show any proposed grad�ng changes <br /> ., • Existing and proposed utilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> . PERMIT CONDITIONS � <br /> 1.AI�calls for inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be performed in accordance with tliis permit and currenl City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Servtr;e 48 hrs.befure you dig.TOLL FREE kUMBER 1-800-424-5555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ._/ The undersigned owner/applicant hereby egrees to hold and save harm- <br /> c1r — less ihe City of Everett from any and all claims lor dainages, costs, <br /> I ��� „ _ ezpenses, or causes ot aclion that may arise because of inslallation <br /> �'�'����� y�n_ / o and maintenance ol the improvement or other right-of•way use heretn <br /> �%�f7/bU7�2i /G Zy/�� applied for and further agrees to remove same upon noiiee irom tha <br /> Approved for Constructi �e Ciry and to alace public property damaged Ihereby. <br /> FINAL INSPECTION Uate � " <br /> Aporoved as Constructed <br /> �ign ure ol Appli ant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWGfiKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Gedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 9820"i CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORI<ON THIS <br /> �} Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br /> �--- . .. . _-- —_ ---�---' <br /> +'i�.?' ,4"t',-r ' a., � . t.a�',�.', ,_. . . . <br />