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�� <br /> Da!e�� r�m��wo�h.a�,m�i. <br /> Applica�ion For 0��g�Dept.a� ! , <br /> 1�r� <br /> PUBLIC: WORKS PERMIT PuoiicWorxsFeo ' <br /> Totel Fao $ <br /> Lc55 Rppl FEn Paid i <br /> 9ulance D�c $ <br /> Print or Type Unty — — <br /> �n,,,�l�r,F�v rs� .1ja 5 'zn n1 �..� /��' .�Aa t�lP u�/� 4���5 5'a �-�r d� r <br /> Owner Mailing Address City Zip Phone <br /> JR.vyl.,(� <br /> Appl�canl Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �Q�(���Jd.j��l2a�QL.�e(�El(� ` `f -Y�9� /,( .�/�� uQ, <br /> Proiect Address(if known) _ I e^Z� �i �ynj10J�7 . � �L <br /> ■ <br /> Attach four(4)copies of plans fur proposed work- Draw to scale snd nole ihe followina s applica6le: � <br /> • Property Lines • Centeriine of sVeel �A <br /> • Outline and dimensions of all existing and • Indicale North V� <br /> proposed strucWrrs on ihe lot • Shew any proposed grading changes <br /> • Existing and proposed utilities • Sho�.v nieasuremenls � <br /> DO NOT WRITE BELOW THIS LINE . � <br /> PERMIT CONDITIUNS <br /> 1. All calls for inspection shall be made 2d hrs. in advance- phone 253•831$. � <br /> 2. AI;work shall be permrmed in accordance wilh Ihis permit and currer�City of Everett Desi9n and Construction <br /> Slandards and Specrications. <br /> 3. Call Loca�ion Underground Service 48 hrs. before you dig.TULL FREE NUMBEA 1-800-424•5555. � <br /> �l ! �E'�/?�/% /'✓�% ✓'=� i';_.iJ - � <br /> CdliC cc�o,�,C:S r �� �-�ru%�:., ��G <br /> :�1 �, � ��/� <br /> j,:�,� V� <br /> �A <br /> 1.6 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneNapplicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any anc' all claims for damages, costs, <br /> expenses, or causes of action ihat may arise because of installation <br /> and maintenance of ihe improvement or othr,r righl�of-way use nereto <br /> applied for and further a�rees to remove same upon notice from the <br /> Approved for Consiruclion Date City and �o replace public property damaged thereby. <br /> FINFL INSPECTION �ate <br /> Approved as Consiructed Signature of.4pplicant Date <br /> everett PUBLIC WORKS DEPARTMENI' WORK AUTHORI2ED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> � 3200CedarStreet !80 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�BB15 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF VJORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />