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r-- <br /> �•- , <br /> i <br /> , <br /> Date1(lTl1/T/a y .-� <br /> Public Warks Porcm�it♦ <br /> Application For BIOB�Dept.r 75 L/�L (,) j j� <br /> PUBLI� WORKS PERMIT <br /> Publi<Worke Fea <br /> Totel Fee S��_ <br /> Print or Type Only Le59AootFeeaaia $-� <br /> Balanco Oue $��-_ <br /> _l�Va C�P�P�y' I`t�c� �C e�P�., �5�//.E�C��i�c��4�/ ,. ,,o <br /> a Maoress ��'!L`i <br /> City Zip Phun�— <br />� �� If1 �� <br /> Applicant Mailing qddress <br /> (� ���Y Z�P Phone <br /> rDescribe Proposed Work (�lD,t�?) �. .T-ff-�' /)� ..L <br /> i ' `� / � .111_,[P-o_`�L.�� S�o1 <br />� <br />� <br /> Pro;ect Address(if known) �/ 7� W <br /> "2 `-. C7'_ � <br /> Attach four(4) ,;opies of plans tor proposed work- Draw lo sca!e and note the lollowin�s applicable: <br /> • Property Lines �� <br /> • Outline and dimensions of all existing and � Centerline o(ctreet � <br /> proposed structures on the lot � �ndicate North <br /> � Existing and proposed utilities � Show any pronosed grqding changes <br /> • Show measurement, <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 tvs in advance• phone 259•881 5. <br /> 2. All work sheli be performed in accordance with this permil and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3. Call Lecation Underground Service 48 hrs. bolore you dig.TOLL FREE NU��IBER 1-$00•424•5555. <br /> � <br /> ��e��L4r� r � <br /> . � ��� � ����� <br /> o �-��� �' <br /> �� 6 ��� � <br /> v ,z �� <br /> // O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant h?reby agrees to hold and save harm- <br /> �ess the Cily of Everett from any and all claims lor damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance ol the improvement or other right-ot•way use herelo <br /> Approved for Construction Date applied for and turther agrees to remove same upon notice from ihe <br /> Cily and to replace public property damaged thereby. <br /> FINAL INSPEC110N <br /> Approved as Conslructed Date <br /> SignaWre of qpplicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 6Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF?Eq IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSl1ED TO COMPLETION, THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPP.4GE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> i <br /> 1 <br />