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•Date�%'�% � 87- 26 <br /> Pu�6c Works Permll�• � �` <br /> Application For eias.oeoi y�—� � <br /> PUBLIC WORKS PERMIT Pu01iCWorkaFee <br /> to�ei Fee s- <br /> , Lees AOP�Fea PeiE ��� <br /> Ba'enceDue S <br /> Print or Type Only — <br /> %c.`�-l/f" /���1//l"�C-G2�✓� .Z.3:71i�� lL'�/�l ��/lrlf�L���� `�,�f��-� <br /> Owner Mailing Address City Zip Phone �l�c—_¢���, <br /> / ff'TI <br /> ��,u � - <br /> Applicart Mailing Address M1 City Zip Phone <br /> Describe Proposed Work f�f/`'�� �������G�'L <br /> Prolect ACdress(it known) �!O�G'S" EG6�':�ao.e LN ��T"t9 D� C�,PES%R�Y'�D � <br /> � <br /> Attach four(4)copies of p�ans br proposed work•Draw to sr,ale and note the lollowing as apolicable: � <br /> • Property Lines • Centerline ol stiaet � <br /> � Outline and dimensions of all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading chan�,es <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NJT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance•phone 259•B81 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current Ciry of Everetl Design and Construction <br /> Standards and Speciticat�ons <br /> 3. Call Location Undergrouno :' avice 48 hrs. beforc you dig. TOLL FREE NUMBER 1-$00•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIOtJS <br /> ,�q� The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City o: Everetl irom any and all claims for Camages. coots, <br /> �/ expenses, or causes of action that may arise because of installation <br /> �✓ !2 /l � 12 87 and maintenapce ot lhe improvement or other righDol-way use hereto <br /> '���`�j� applied lor and further agrees to remove same upon notice trom the <br /> Approved loi Consvuction ate City�r�C90 replace public property dam8ge�hereby. <br /> �7 C! � � � <br /> �// /•�f� /� �i <br /> FINAL INSPECTION Dale ��GC Y � � �� �'" '� <br /> Approved as Construcletl � Signalu ol Applicanf� Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> � 3200 Cedar Street 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 96201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />