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i <br /> � <br /> � <br /> � <br /> . , <br /> ('�—� S �3s• Z9- �{ ,�" <br /> Date�� P��GicWarksPermi y��� <br /> Application f or Bm�� Deai.+ �. <br /> PUBLIC WORKS F'ERMI'1^ PubhcWoiFSFee - <br /> �o�,�F�� s <br /> Less �nn� Fae Pai� S <br /> Dalance Duo $ Z�L <br /> Print or Type Only <br /> �1;r��P _�-�x a�S� � �.r�-1- 9�ab3 �17-���5 <br /> Owner Mailing Address Ci�y Lp Phone <br /> k k <br /> Applicant Mailing Address C�ty Lp Phone <br /> Descnbe Proposed Work � IF"� 1 t J� <br /> Project Address lif knownl � Ca ZZ �hQ�A^�'cA �C�RA' � I <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of all esisting and • Indicale North <br /> proposetl 5trucWres on ihe lo� • Show nny proposed grading chanres <br /> • Ezisting anE proposed uldities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Conslruction <br /> Standards and Specilications. I <br /> 3.Call Location Underground Service d8 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � i <br /> i <br /> O � <br /> � II <br /> � II <br /> O I <br /> a <br /> ACKNOWL[CGGMENT OF CONDITIONS <br /> � � �� The undersigned owner/appli_aM hereby anrees lo hold and sa��e harm� <br /> less the Ciry ot Everelt Irc�n any and all claims lor dama�es, cosls. <br /> ezpenses, or causes ol action that may arise because of installation �� <br /> �� l I �r � and maintenance ol the improvement or other righhof-way use hereto � <br /> � `_ �•`C�—'�"`- ( � � � �� applied lor and furlher agrees to remove same upon notice Irom Ihe <br /> Approve �or Consiruc 'on Date City and lo replace public property damaged ihereby. I <br /> / �� <br /> �LI�'(/�/ C� '-Z 'Jc� �( /� I `J ��/y�� <br /> FINAL INSPECTION Date =�t�"�� �� <br /> Approved as Constructed Si9n ure ol Ap� nt ` Data <br /> WORK AUTHORIZED �Y THIS PEFMIT MUST BE STARTED WITHIN �.. <br /> everett PUBLIC WORKS DEPARTMENT 130 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200CedarSlreet pE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE . <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> I <br /> � <br /> I <br /> I <br />