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( <br /> I <br /> ( I <br /> /f <br /> � /�Q�� —� `�Y`� I S <br /> g': <br /> Date S - 36"Z`� a�m��wo,ks ae,�. r <br /> '��� � Application For BWp.Oept♦ <br /> i <br /> ° PUBLIC WORKS PERMIT P°°°°W°«,F°° - '� <br /> T��<�Fae s <br /> Lesa Rop�Fee Paia S r� — �' <br /> 6alanca Oue S L� <br /> Print or Type Only <br /> �t��t�Y- �l��,l �10� S.� � ) (/.�/��i.�y�_g�D-.�, I <br /> Owner Mailing Address City � Phone �, <br /> ������ <br /> Applicant Mailing Address Cily Zip Phone �. <br /> Describe Proposed Work �d�r=Y—� � <br /> W �� <br /> Proiect Address(if known) I � �� ����L—MC'����-- L_�NL � <br /> Attach four(4)copies of plans for proposed work- Draw to scsle and note the tollowing as applicable: � <br /> • Property Lines • Centerline ol streel � <br /> � Outline and dimensions ot all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposc•a gradinS changes <br /> • Existing and proposed utilities • Shew meas�vements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls ior inspection shall be made 24 hrs.in advance-phone 259•8810. � ; <br /> 2.All work shell be performed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards end Specifications. � ;;�� <br /> 3.Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1-800-424-5555. � �;,f <br /> #,' <br /> O <br /> � '`:.� <br /> � � <br /> � � <br /> a � <br /> � ACKNOWLEDGEMENT O�CONDITIONS �� <br /> � <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City ol Everett trom any and all claims tor damages. costs, <br /> � ezpenses, or causes ot aclion that may arise because ol installation <br /> -��C � 4M�K t`. c�.-/72 /�U �0d mainlenance ol Ihe improvement or other right-ol�way use hereto � .-,�� <br /> P�c �� � a h lor and turth rees to remove same upon notice from the <br /> Appwved (or Constr�on /' �! �a�e C y a d to replace p blic property damaged thereby. , <br /> ��--�/ -- � --� r- -�, r �'1 a,� � 9 0 � <br /> FINAL SPECTION Date � <br /> Approved as Constructed SignaWre ot Applic�nt Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> rverett PUBLICWORKSDEPARTMENT 1g0 DAYS Of DATE PERMIT IS 13SUED AND THEREAFTER IS TO <br /> � 3200 CeCar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> i <br />