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i <br /> � <br /> I <br /> i f <br /> Date�rz'��� � -3� -2'9-`{ PoplicWa�ISPormi <br /> Application For eiee oem+� <br /> PUBLIC WOR�CS PERMIT P°���°W°�k=��° <br /> Total Fee $ <br /> les3 ApO�Foe PniU $ <br /> Print or Type Only ea�a��o o�e S �� <br /> �'�� ��� �� r��� �ig� �c,�s�et�- �� �7 3� <br /> � Owner Mailing Address City 2ip Phone <br /> C [ �l <br /> Applicant Mailing Address City Zip phone <br /> Describe Proposed Work �� `�J � � (�`���/��� <br /> W <br /> ProiectAddress�ifknown) � � �g ��71.A.�17 /JV� � <br /> Attach four(4)copies oF plans for proposed work- Draw to scale antl note the followin{�as applicable: � <br /> � <br /> : � Properry Lines • Cen�erline ol sireet �lh <br /> � � Outline and dimensions of all existing and • Indicate Nurth V� <br /> proposed structures on the lot • Show any proposed grading changes � <br /> � � Existing and proposed utililies • Show measurements � � <br /> DO NOT WRITE BELOW THIS IINE <br /> PERMITCONDITIONS O , <br /> 1.All calls tor inspection shell be made 2a hrs.in advance•phone 259•8810. [�5/11��Q0 4:�bPM OOORH1497 � �� <br /> 2.All work shall be peAormed in accordance with this permit and cu«ent Ciry of Everett Design an �nstruc ion � <br /> Standards and Specifications. ' <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-���. � I <br /> BLDG 5401.68 i <br /> FL6G S95.00 O ,'I <br /> ifECH 5110.00 <br /> E SRCH 54.50 <br /> DRUW'1 Si0.00 � <br /> HOOOOb813 <br /> WATER 860.00 �/� <br /> HOOD27716 N♦ <br /> SEWER 930.00 O <br /> 1171•-5 4813.00 <br /> END II S^c70.IX1 � <br /> CHECf: 51804.iB <br /> � ACKNOWLEDGEMEN'OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Ciry of Everetl irom any and all claims lor damages, costs. <br /> �� n ,.��1G /_ � �/� � i ezpenses, or causes ol action Ihal may arise becau;e of installation I <br /> K /�/ �OD j1�' and maintenance ot the improvement or other right•ol�way use herelo <br /> a,>plied for and furlher a�rees to remove same upon notice irom the <br /> Appro ed lor Constr lion Date Ciry and lo replace public property damaged thsreby. <br /> ,Q��l�-- �1 r--./ �����:���?/�-> ,S�i/`�o <br /> FINAL INSPECTION Date <br /> Approved as Constructed i9 ue ol Applie�rtl Date <br /> � WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN , <br /> everett PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> � 3200 CedarStreet BE DIUGENTLY PURSUED TO GOMPLETION. THIS PEHMIT MAY BE I <br /> E��erelt,WA 98201 CANi,ELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona 253�8870 PROJEGT OVER�0 DAYS DURATION. � <br /> � <br /> i <br /> I <br />