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87- <br /> yF /{y/3 <br /> Date S/5 Public Works Permit# / <br /> Bldg.Dept.# <br /> Application ,gr <br /> N PUBLIC WORD PERMIT Public <br /> Works <br /> Total FeeFee $ <br /> CI <br /> QLess Appl.Fee Paid $ <br /> atat $ ��� <br /> Print or Type Only x al ci,, Balance Due <br /> 0.., 6 di' <br /> Lo ca ra <br /> ,P-tutAilc S iftectit--Q, toe CrAte(44 . ea)vePett- WP.DI ersq--4,'7 7-7 <br /> Owner Mailing d"cit� � City Zip Phone <br /> PralVA‘VA•tt-t_ hoof a § 444.,rTi ,/tiNcil 4t,P 2d ( °-‘7 Z. <br /> Applicant Mailing Address City c <br /> w <br /> Zip Phone <br /> Describe Proposed Work a�t "e w eA- 0 Y e-vJ 4 <br /> 1 -_ �► <br /> Project Address(if known) IOC? 'frfv1 rAA( f 0l--'4r Ctt <br /> 11.1111 <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: iii <br /> • Property Lines • Centerline of street /w <br /> • • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> COI <br /> DO NOT WRITE BELOW THIS LINE 0 <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction iminj <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> 0,'/ � J 7a .//G jf ,8� /2"i�X/rr�rery, OF— /" ` 0 <br /> 444L.t� 757,t1 ..7i✓si/9GG.6c21 �',ee e;'Ti S7.�i✓.4.,�.ez, <br /> 1Y3c 7 7 e9440 E i2aAl 3 3.7_ <br /> CO <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned 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 of action that may arise because of installation <br /> j -� /89 and maintenance of the improvement or other right-of-way use hereto <br /> !`/--` `-_, applied for and further agrees to remove same upon notice from the <br /> Approytsd for Construction,.- Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date '1_ t <br /> Approved as Constructed Signature of Applicant Date <br /> / \ WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everette PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,320 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> J Phone:259 8810 PROJECT OVER 90 DAYS DURATION. <br />