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� Date�rl.jQ / PublicWorksPB�mil• �'�J� <br /> 1 Bldg.Dept.• ���� <br /> i Application For <br /> PUBLIC WORKS PERM;T P°°°°'"°"6FBe <br /> To'al Foe S <br />� Los9 FpP�Fee PnIE � <br /> Baiance Due S L� <br />' <br /> Print or Typ�; Only <br /> i • <br />� ,��,�� � 1�h.�r �!ell� �z� S ti��ir.�sp,- .��/2fP (�- Ct�` ZO/ Z59- 4-�9Z <br /> Ownei Mailing Atldress City Zip Phone ( <br /> NPr�)�� / /lJl(`�/.in�/f� I L��b �'. �i !Y'x /l� �l / YA Z�Y/ iC�7'/ l�/ <br /> Applicent Mailing�Address ity Zip Phone <br /> Deacribe Proposed Wurk � � ��� � �L.����'�'�` �y�e J — <br /> '�f 3d L�(`.�n���0�4/�n _ <br /> �� <br /> � <br /> Project Address(if known) ���l G (� p ^P�;!�Q� � <br /> Attach four(4)copies of plens for proposed work• Draw to scaie and note the following as applicabla: � <br /> • Property Lines . • Centerline of street � <br /> • Outline and dimensions of all existing end • Indicate North <br /> proposed structures on the lot • Show any proposed gradin9 changes <br /> • Existi:.g and proposed utilities • Show measurements M <br /> W <br /> DO PJOT WRITE BELOW THIS LINE O <br /> PER�AIT CONDITIONS <br /> 1. All crlls for inspection shal�be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shell be per(.:rmed in accordance with this permit and current City of Everett Design and Construction <br /> Stendards and Specifications. <br /> 3. Call Location Uncarground Service 4B hrs before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> f,r1f/ ,�Emodqt oF ��r�.���.ny l+�.Ec.�.rs.s,ey SN,�c � �{ O <br /> (,'�ornpL,ErEt� %p T//E tS'9TiSF9CTio.✓ Ot T.�E /�uduG <br /> �/p,Q,ft .cti:Ir2�c>o.�„ ■ <br /> r <br /> N <br /> O <br /> a <br /> 4CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby aprees to hold and save harm- <br /> less the Cily of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise bec:�use of installation <br /> � i 7 a and maintenance of the improvement or other right•of•way use hereto <br /> 1� » applied for and further agrees to remove same upon nolice from the <br /> Approved for Constr n � � �e Ciry and to replace public property damaged thereby. <br /> o?- �- �� ---�L 4 � 7�3� � 97 <br /> FINAL I TION Date <br /> Appro�+ed as Constructed Signature of Applicant ate <br /> PUBLIC WORKS DE?ARTMENT WORK AUTHORIZED BY THIS PEFlMIT MUFT BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUtD TO COMPLETION.THIS PERMIT MAY"'�� <br /> Eeerett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON' � <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURAI'ION. <br />