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i <br /> i I�I�I�`s�' <br /> Date PuOLCWpdsPer �� c`�f�— J <br /> Application For eiae�ocoi.• <br /> PUBLIC WORKS PERMIT PubTat�IFeeFee S — <br /> Less FOPL Fee Paitl S <br /> Print or Type Only e�m��oo�a s_ 2D�— <br /> l Ini r� 1-�i�nn ►�o l�r�X -ti�? �L qR�DI� ���L9�. <br /> O r Mailing Address Cdy Zip � Phone <br /> �� <br /> Appl�cant Mai�ing Address City Zip Phone <br /> Describe Proposed Work � �"-� �� L r / ����I� <br /> b <br /> P�oject Address(if known) �O� — ' � <br /> Attach lour(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol streel � <br /> • Oi.tline and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposetl g�ading chan�es <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 pedormed 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.before you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> �Pi�o�,� '�y��� � _ Z <br /> u�Ceveesy 'Geu�-ce�f e�ao�jL¢�� O <br /> �.-�:� � ��t -� � � �-.�,.�� � .�os ��-� <br /> r,G�G��`-� �uw v��� ,¢� ��1 z./ �'��07 � � <br /> Se,�,�.:e-,. 3,3. T (�7,Z7`�c�.�> f O <br /> � � v� e� Vt � U e o d� <br /> ���. � I �W I <br /> � cl i'�c v e Ul-e' C'��i v� � G10 � <br /> r��o � pI <br /> \ I� � � S (� . ��l ACKNOWLEDGEMENT OF CONDITIONS <br /> � The url�e�c�ned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of aclion that may arise because oi installation <br /> ���� �j���8 and mainlenance of the improvement or other right-ol-way use hereto <br /> Approved lor Con$ruc((��n �� Date apphed lor and lurther agrees to remove same upon nolice Irom the <br /> _ //��� City and to replace pu6lic property damaged thereby. <br /> _f��`�i <br /> !G - y'-d=� �1J// �1 <br /> FINAL INSPECTION Date I .c� lc- Y?JO I t �(�i� �-Z�-g9 <br /> a �7nature ol A plicant Date <br /> eve�elt PUBLIC WORKS DEPARTMENT WORK AUTHORIT[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStr=et 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Phone:259•8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />