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,� JJ c�� ' 7 <br /> Date � � • 8(e -�59 <br /> PuoLc works Per t� _-7--- <br /> Applicatlon For eiao oea�.._�e,�/ L���� <br /> PUBLIC WORKS P�RMIT PUbTotalfeaF^� : - <br /> , . Less Apn�Fee PoiO S <br /> Print or Type qnly �j o� <br /> Balance Due .S G Q� <br /> � O„ -.��.�--� 1!-(��rnC � � )7 -�l i rh�ocX �7�- 0000 <br /> Owner Mail�ng qddress City Y�� Z�p Phone <br /> plicant Mailing Address �i� <br /> Y Zip Phone <br /> Describe Proposed Work _ �l /�� <br /> Project Address(i� known) _ ���J if/��y � <br /> Atfach four(4)copies of plans lor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of a�l existing and • Indicate North � <br /> proposed siructures on the tot � Show any p�oposed grading chan9es <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CC NDITIONS O <br /> 1. All calls lo•inspection shall be made 24 hrs. in advance•phone 259•881 5. <br /> 2. All wo�k shall be perlormed in accordance with this permit and current City of E�rreit Design and Construction ' <br /> Slandards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBFR 1-800•424•5555. <br /> sE"u,�E.� r�9.,v �/ E,✓Gt.r��p f,'1��" `n,9y ,vor BE � <br /> G�W Cn/ovG�/ TD SE',evE �ATN�O�� �N THE O <br /> LO[dE.e L6dEG �� T�vi,t /'pUSE , � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicent hereby ac�rees to hold antl save harm- <br /> ^ , ' less the City ot Everett Irom any and all claims lor damage::, costs, <br /> �j�� � expenses, or causes ol action that may arise because ol installation <br /> �' , g6 and maintenance of Ihe improvement or other righl�ol•way use he,-eto <br /> Approved for Corrs�ruction pa1e applied lor and turiher ac�rees to remove same upon notice trom tne <br /> ��� City and to replace public property damaged Ihereby. <br /> S•/ Z-�7 ' J <br /> FINkt1N5PECTiON � �,y <br /> Date ��?i���C` n— ,..� � 0��� <br /> ApprovetlasConshucted Signatur��- e^o(App�ica❑ — <br /> Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED D'/ THIS PERMIT MUST BE STARTED WITHIN <br /> � � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS iSSUED AND THEREAFTER IS TO <br /> Eve�ett.WA 98201 BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON qNY STOPPAGE OF WORK ON THIS <br /> PRUJECT OVER 90 DAYS DURATION. <br />