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p fl�@ '.�/p �p..,�' Pubim Worka Perm�t• � <br /> �v <br /> B�eg.Oept• <br /> Apptication For <br /> PUBLIC W4RKS PERMIT PueTo�FeeFee s <br /> Less Apo�Feo Paia S p <br /> Balonte Ouo S �n� <br /> Print or Type Only <br /> r�lt/' �D14f11C� ��9�Z IZuC p� �� �3 FI/Pfp�" C/cQ"2D� �SZ—��.3 <br /> wner MaiVing Address City Zip Phone <br /> �Q _ ..o :��C fIRD� ��v�i 99 S ��a��7y� 9�zo�l 353-9Z4� <br /> pplicant Mailing A�ss—T City �iv Phone <br /> Describe Proposed Work _ n A W .0 i��..��}9/��'��� _ <br /> r� <br /> y6zi - v.�.c'�,,�. � W <br /> Prolect Address(if knownl ��— � <br /> Attach lour(4)copies of plans tor pror.osed work- Draw to scale antl note the following as applica6�e: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions o�all existing and • Indir.ate North <br /> proposed structures on the lot • Show any proposed 5rading changes <br /> • Existing and proposed ulilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor 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 Construclion <br /> Stenderds and Spacifications. <br /> 3.Call Locetion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•$00•424-5555. � <br /> �f/'/�� Sclvc,� �'Gu.s*/cGTn�/ jo S�t�r�2 //� � <br /> �lf�,ey�.r,�,o 9��: s�'..� f>.�,c.s-�;o s,���c�/_ <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees t�hold and save harn� <br /> ' less the City ol Everetl irom any an� all claims for damages, cosls. <br /> ��',�-G S��7UD/�'�s��B ezpenses. or causes of aclion that maY arisr hecause ol installation <br /> and maintenance ol Ihe improvement or othei .�ght-ol-way use hereto <br /> app eJ for A further agrees lo remove sar> upon notice from the <br /> Approved br Constructio � / a�e Ci and p e ic properry damageo the�eby. <br /> �L6'.�i%V ! / .. C�.v� '�� � O O <br /> FINAL INSPECTION Date <br /> Approvetl as Constructed Slgnature ol Applicant Date <br /> WOAK AUTHORIZEC B H�5 PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPAR7MENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evera�4 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-BBiO PROJECT OVER 90 DAYS DURATION. <br />