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f <br /> .T("_�_ ___—___" ..,r. _ __ _"__'___.'__....__—___ -�-__.._.__-,.._. __.... _- _'.. . . ""�-��.. __�.��....^.�..��. <br /> � <br /> Date 8/13 90 �1 �� Publ¢\YmMSPormil♦ <br /> Bitlg.Depl.s 9��25345 <br /> Application For <br /> PUBLIC WORKS PERMIT PUOTotIFceFee § -- <br /> Less Fppl.Fec Pai� 5 <br /> Balance0ue $ <br /> Print or Type Only <br /> 1201 Asso L nwood 98136 771-9070 <br /> Owner Mailing Address City ZiP Phone <br /> Owner — <br /> Applicant Mailing Adtlress City Zip Phone <br /> Describe Proposed Work �nant Im =� OVament <br /> _ W <br /> Projed Address�if known� 1203 "J" SE �Veiett� Way � <br /> Attach lour(4)copies ot plans for proposed work� Draw to scale and note the following as applicable: � <br /> Y Property Lines • Cen�erline of street ♦A <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed siructures on ihe loi • Show any proposed grading changes <br /> • Existing antl propo�ed utilities • Show neasurements /�A <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AI�calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.Atl work shall be pertormed in accordance with this permit and current City of Everett Desi�n and Consiruction <br /> Standards and Specifications. <br /> 3.Cal!location Underground Service 48 hrs.before you dig.TOLI FREE I�i�n�seR 1-800•424•5555. � <br /> /� /� n /�j 0 <br /> . �/J�.�.L'.LCJO:'l�ii J`"-�'%.y��L� /�(`�/ /CQ�h.�.J/ <br /> i —l/� /,/�� � <br /> I ,' X'/i:/C //�l''✓/��2_ <br /> `7� <br /> 9 -i�-�� � <br /> a <br /> i <br /> ACKNOWLEDGEMENT OF CONOITIOtJS <br /> j The undersigned owner/applicant hereby agrees to hold and save harm� <br /> � less the Ciry of Everet� from any and all claims tor damages. costs. <br /> j expenses, or causes o� action that may arise because ol installation <br /> � and maintenance of ihe improvement or other righl-ot�way use hereto <br /> I <br /> I applied tor and lurther agrees to remove same upon notice from the <br /> �� Approved for Construction �a�e City and to replace public property damaged ihereby. <br /> I _ <br /> i FINAL INSPECTION Date <br /> ApproveA as Constructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everntt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> EveretL WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> i Phone:259-8810 PAOJECT OVER 90 DAYS DURATION. <br /> I _____ — <br /> l'_—___ � _ --_____-- <br />