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Date� R� �S �7,c--//;. � <br /> Vubt�c WorMs Permit e �/ r- <br /> Application For eiao.neai,���� <br /> PUBLIC WORKS PERMIT PuoTolalFeeFea f __ <br /> Less ApO�Fee PaiC S <br /> 7� <br /> Print or Type Only ea�e��e o�e a �-�� � <br /> � 7�E O� <br /> �T- <br /> �i►„ � G'�•G,�I ,Q��W�av �� �tX .S3 L/ �.�-z?9`Gl�i� �BZo6 .�Yd'�U <br /> Ownei Mailing Address Cit <br /> ^\ ' Y ZiP Phone <br /> �" m� �� �� Y.7f.. <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work ���ltTrtic�� C�,h /�7i��f �QG� ,�,��� �Li^���-- <br /> 0/; ��' _.reyL m` /17�L-C �/�� �'-- — <br /> ProjectAddress�itknown) � �LGvU/ /ni9L4 �'� _ � <br /> Attach four(4) copies of plans lor proposed viork- Draw to scale and note the lollowing as apUlicable: � <br /> • Property Lines • Centerline of stree� � <br /> • Outline and dimensions of all existing and s Indicate Norih � <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � � <br /> 2. All work shall 6e performed in acwrdance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREI' NUMBER 1-800•424-5555. <br /> �, �a � �� r� � /��-r�-�-� �'�o_,�d -�yl--��s� Z <br /> / � <br /> ♦�A <br /> V♦ <br /> 0�q <br /> 1.�. <br /> ACKNOWL[DGEMENT OF CONDITIONS <br /> The undersi9ned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes ol action that may arise because of installation <br /> ��y� /�,��_� „� , 1�� and maimenance of the improvement or other ric�ht�of�way use hereto <br /> --�� applied for and furiher a rees to remove ssme upon notice from the <br /> Approv d for onstru�tion Uate City and to� laCe publio property damaged thereby. <br /> l (� <br /> � . . � �l✓� i � ��//�� <br /> FINAL INSPECTION Date �L�"v �Lb '2— -�/�� <br /> Approved as Consiruqed Signature of Applicant � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AU7HORIZEO BV THIS PERMIT MUST aE STARYED 1NI'HIN <br /> � 3200CedarStreet 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, Wq g820' BE DILIGENTLY PURSUED TO COMPLETION. THIS PER�11T MAY BE <br /> Phone: 259-8815 CANCELLED E3Y THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> � PROJECT OVEF AO DAYS DURATION. <br />