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pate�G a�oi,�wo,ks ve�m i. �— <br /> ema oe-:.._�'y^'.��(0 /�� <br /> ppplication For � <br /> pllBL9� 3N(�RKS PERMIT P'���cWorkaFae — <br /> ,o�a,Fea s--- <br /> Less FG�I.Fea PaiU $ <br /> Balance Due � <br /> Print or Type O�ily -- <br /> �r�,w�n �i- {�s.sD C : �7��7 5�..%A Lt N /�(�'' ���n ti l F G�J/� �' ��S 5 a � -aG�✓' <br /> Owner Mailing ACdress City 7.ip Phone <br /> �App'rl c nt Mailin3 Address City Zip Phone <br /> Describe Proposed Wurk !�� �vrii`��NA� �AN��(yjl�J�O����J.[��[(�,yj./ <br /> __ � <br /> ProlectAddresslifknown) _���/ ��/(��1/��� �/'�!� ���� � <br /> � <br /> Attach four�4) copies of plans for proposed work- Draw to srale and nole the lollowing as applicable: � <br /> • Property Lines • Centerline ol street !A <br /> • Outline and dimensions�!all exisling and • Indica�e North V�/ <br /> proposed siructurr:s om.the lot • Show any proU��ed gratling changes <br /> • Existing and proposed utilities • Si�ow measurements /� <br /> W <br /> DG NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDII'IONS <br /> 1. All calls(or inspection shall be made 2a ni s.in advance� phone 259-881 5. � <br /> 2. All work shall be pertormed in accordanu� �:i'h ihis permit and current Ciry of Evereti Design and Con;truction <br /> Standards and Speciticalions. <br /> 3. Call Location Under�rourd Service 4A hrs. before yeu dig.TOLL FREE NUMBER 1•800-42d�5555. � <br /> /ri� 7�U�G/C �-2>O,Er�==s' ��E2��/T ,��G'�j'U�,��..� O <br /> . <br /> ���8� � � <br /> �� C� <br /> a <br /> ACKIJOWLEDGEMEN?OF CONDITIONS <br /> The undersic�r�ed owner/applicant hereby agrev.s to nold and sava liarm� <br /> -- le,s the City of Everett trem any and all claims for damages, cosis, <br /> expenses, or causes ot ac�ion �hat may ariss because of instaliation <br /> antl maintenance ol ihe improvement or other right-ol-way use hereto <br /> applied tor and further agrees to remove same upon notice Irom lhe <br /> Approved for Conslruction Date City and to ieplace public property damaged thereby. <br /> FINAL INSPECTION Date �J� ' — <br /> Approved as Construcled � Signature ot Applicant Date <br /> PUBLIC WORKS UEPARTI�IENT WORK AUTHORIZED BY THIS PERtv11T MUST BE STARTEU WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PUHSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CAVCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8875 PROJE.^.T OVER 90 DAYS DURATION. <br />