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! <br /> I <br /> I <br /> I <br /> --- _ _ - --- - - -- <br /> _ _____ _�., -- -. _ _ - � <br /> - - - -__ _ . <br /> r _ _ , , <br /> `/��, //� .� g 33 ; <br /> Date�a�� / � ' �� � .1 �� PuL ic Wmks Pormit+ _ � � i I <br /> � , � <br /> eie9.o�w •1 I � <br /> Application For � i <br /> � PUBLIC WORKS PERMIT PubTotelFeeFee S ! I <br /> � Less Fppl Fee Paid S O <br /> G I <br /> Balance Due § ���� <br /> Print or Type Only <br /> 1 I /1/-((' ��'%J i�,�( <br /> Owner Mailing Address City Zip Phone <br /> ������r�� <���7, f � 9��.1 'in��� ��� l�t Gl ) �l �� - �Z�r`���� -���.� <br /> Applicant Mailing Address Ciry Zip Phcee I <br /> Describe Proposed Work � /J � ��}-'—� � r� �V� � " F`� 1�i� ���"� � <br /> � � � � W <br /> Project Address(if known) _ / � ��� a '� � I <br /> Attach four(4) copies of plans fo'proposed work- Draw to scale and note the following as applicabie: � <br /> • Property Lines . � Centerl�ne ol slreet r.� I <br /> � Outline and dimensions of all existing and • Indicate North �� r <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NUT WRITE BELOW THIS LINE . � <br /> I PERMIT CONDITIONS ', � <br /> � 1. All ,:alls fo�inspeclion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> � 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Constrnclion <br /> S'andartls a�d Specifications. <br /> 3. Gall Location Underground Service 38 hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ;i� The undersigned owner/applicant hereby agrees to hold a.id save harm- <br /> � less the Ciry of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action ihat may arise because of installation <br /> �_%���� /,r� �1�` /�/ B/Br and maiolenance of the improvemenl or other right•of-way use nereto <br /> I ,(/J/f/ Oa-/f appiied lor and further agrees to remove same upon notice from the <br /> Approved for Consiru ion Date �i�y and to replace public pcaperty damaged thereby. <br /> �� � <br /> � � , �...-_._ � ..%-._--- /:7^„/ y � �tt <br /> FINAL INSPECTION Date �� � � .' � <br /> Apnrcved as Consiructed Sign�"alure ol Applicant i Date <br /> WORK AUTHORIZED BY THIS PER MUST BE STARTED WITHIN <br /> everett FUBLIC WORKS DEPAHTMENT 7g0 DAYS OF DATE PERMIT IS ISS•, D AND THEREAFTER IS TO <br /> � 3200 Ced�r Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Plione: 259-8875 PROJECT OVER 90 DAYS DURATION. <br /> i <br /> I <br />