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�2��8� Pu01ic Works Permlt s 85-/5Z <br /> B�tlp-Depi.• <br /> Appiication For <br /> PUBL,IC WORKS PERMIT °°°TOWFaoFBB S <br /> �oss APpI Feo Paitl $ <br /> Balance Due S /72 • �� <br /> Print or Type Only <br /> ��!� �t��N �I 1 �'�v-3v�,s� �l£nerr 9�� �S7_- 2� <br /> Owner Mailing Address Cily Zip Phone <br /> WA, �,� �TA1�l,� �� ����-� �� -�,— yazd3 3�- -�-��- � <br /> Applrant Mailing Address Ciry ZiP Phone m <br /> Describe Proposed Work ��S�VV�� r V� /n� � ���j�� � �' <br /> �.i�/ �l/a��.�'z. �'. � �, <br /> .. � <br /> N S <br /> m <br /> v <br /> W = � <br /> m� <br /> � � m <br /> Project Address(if known) �� � _ � <br /> Attech four(4)copies of plans for proposed work• Draw to scale and nole lhe following as applicable: � m M <br /> • Property Lines • Centerline of street � � z <br /> • Outline and dimensions of ell existing and • Indicate North <br /> proposed structures on the lot � Show any proposed grading changes � _ <br /> • Existing and proposed utilities • Show measurements M -�-I ��i+ <br /> W � �, <br /> DO NOT WRITE BELOW THIS LINE O �3 <br /> PERMIT CONDITIONS � m <br /> x <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. m '-' <br /> 2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction � oo � <br /> Standards a�d Specifications � m <br /> 3. Ce�l location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � m N <br /> z c� <br /> -i r <br /> '� To 1j� �OrtIST�C//GY�cO PE�' AF'P,�avc.o O ' � <br /> f�Ld.r/S I�dr� S 2�f-9-s� -a <br /> � <br /> n <br /> z <br /> � � <br /> x <br /> .. <br /> O N <br /> z <br /> 0 <br /> a � <br /> � <br /> �., <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less tne City of Everett Irom any and all claims for damages, costs. <br /> expenses, or causes of aclion that may arise because of instaltation <br /> �.�//_�p�i� s ��BJ and maintenance of the improvement or other right-ol-way use hemto <br /> ��J) /f> pplied Ibr and lurther agrees to remove same upon notice Irom the <br /> Approved for Co truction �a�e City and o replace public properry damaged-there�y. <br /> -� <G�_ ��� d� �� /,�i, ; l <br /> FI�L INSPECTION Date � � ' �- Date <br /> Apprcved as Constructed Signatu�'o pplicant ' <br /> WORK AU � ORIZED BY THIS ERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DAY OF DATE PERMIT/fS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet 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 /> Phone: 259•8875 PROJECT OVER 90 DAYS OURATION. <br /> ;:ri.v�,�:�.°:� <br />