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. r <br /> ..�_�• , i2- � -7 s-4 9�/zc <br /> Date�_� :, I ; T. C' � " Fubl¢Work5Po1�1+ � <br /> ���M <br /> Application�For Bieq.Dep�.• y� �`-"�i <br /> � <br /> PUBLIC WOF�KS PERMIT Pu�licWorksFee <br /> Total Fee S <br /> Less AOo�.Fee Paia $ <br /> P;int or Type Only °a1nCODoa $ � <br /> S,�-r�a D ,QQ�cI. �� 9 C°��c�'v��, `�C� �j ��� 3c�-�n. <br /> Ow r Mailing Adtlress Ciry Zip or,a <br /> D� <br /> � Applicant Mailing Address City Lp Phone <br /> Deacribe Proposed Work �v � _ <br /> �� l �. W <br /> Projecl Address U� knownl aQ �•�Je-• L <br /> r <br /> Attach lour(4)copies of plans lor proposed work- Draw to scaie and note the following as applicable: � <br /> • Property Lines • Centerline ol street /w <br /> • Outline and dimensions of all existing and • Indicate North V, <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezistino and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be mdde 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and wrrent City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4A nrs.before you dig.TOLL FHEE NUMBER 1-800•424•5555. � . <br /> A <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDG�MENT OF CONDITIONS <br /> The undersigned ow��c•iappli;cant hereby agrees to hold and save harm- <br /> iess ihe Ci;y oi Everett from any and all claims for dama�es, costs, <br /> .�� exoenses, or causes of aclion ihat may arise t�ecause of installaliun <br /> �� !.,' C��T �,���_.c�� and maintenance of the irt,provement or other right-ohway use hereto <br /> �� � apP��ed for and further agrees to remove same upon notice from the <br /> Approved for Constructio �� Date Cily an to replace ublic property damaged ihereby. <br /> ��, � e: S�.Z / <br /> � ����i _/ t6 �-[, <br /> PINAL INS^ECTION Date ^'' �/ <br /> Approved as Conr�ructed ignature of Applicant Date <br /> everett PU91.IC WORKS DEPARTMENT WORK AUTHORIZED E HIS PERMIT MUST BE STARTED WITHIN <br /> � 32JOCedarSUeef 180 DAYS OF DATE E IT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98?O7 BE DILIGENTLY PURS ED TO COMPLETION. THIS PERMIT NAY BE <br /> Phon.•�259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK C N 7HIS <br /> PROJECT OVER 90 DAYS DURATION. <br />