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, a., , , ' . e', - . - .T - ' "" �Sr�'It. (�� �'�.�,.rI�^x ^�'•I�N*(: a'.: � �aY .. +r+:::�T':�� .. .. . •.4 <br /> oe�e��d,. � (� � <br /> Pu�bc Wor�!�rmit• <br /> Applicatlon for eido.wm.r_��T/X'i <br /> PUBLIC WORKS PERMIT PubiicWo��aFoe <br /> Totel Fee S <br /> Las��OPI.Fee Paitl S <br /> Print or Type Only ee�.��«o�e s <br /> � s � -.,1d 8' <br /> � ���JlG�7� /7USP�n .� �7_� -uii� (,!� r l� i�� � f- yi%. N� iti%� yVo�� Zi_ <br /> wner Meilmg Address City 2ip Phone <br /> S�, ,� <br /> Applican� Mailing Atldress Cily Z;p Phone <br /> Descrlbe ProPosed Work r -�r �y��� � ���_�c ti ;,��.-,�P �r'.,c�i�! l' �, . <br /> J <br /> Pro�ect Address fif knownl (%' �n�/ 7 ��r ��7, f p// �� � /1 � <br /> Attach four(4) copies of plans for p�oposed work- Draw to scale and note the lollowing as applicable: � <br /> • PropertV Llnes � Cen;erline ol street � <br /> • Oulline and dimensions of all existing and � • Intlicate North <br /> proposed structures on the bt � • Show any proposed grading changes <br /> • Eaisting and proposed utilities � • Show measurements � <br /> DO NOT WRITE BcLOW THIS LINE � <br /> PERMIT CONDITIONS � i <br /> 1. All calls far inspection shall be made 24 hrs. in advance- phone 259•881 5. � I <br /> 2. All work shall be pertormed in accordence with this�permit and current City of Everett Design and Construction <br /> Standerds and Specilications � <br /> 3. Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> c� f�r',�:�'�' �/C� �'--�'Gi��=,d , <br /> P �y- �/�� O <br /> ,__� , I-- <br /> ''_". `� � <br /> O <br /> a. <br /> . _ <br /> ACKNOWLEDGEMENT OF CONDITIONS ! <br /> The undersigned ownei/applicant hereby agre�:.to hold and save harm- <br /> less the City of Everett Irom any and all claims for damages. costs, <br /> expenses, or causes ot action that may arise because of installalion � <br /> and maintenance of the improvement or other right•ol-way use herelo I <br /> applied lor and luriher agrees to remove same upon notice irom the <br /> Approved for Construction Date City and to replace public properDi damaged thereby. <br /> I <br /> FINAL INSPECTION pate i <br /> Approved as Constructed Signature of Applicant Date <br /> eveiett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARiED WITHIN <br /> � 3200 Ceder Street 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO i <br /> Everet6 WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS ' <br /> PROJECT OVER 90 DAYS DURATION. � <br />