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Date .�/7 � ' , ,...a�oeowo,..aa,mn. <br /> eiaa.oem.. 5'/�a 6% y y <br /> Application For <br /> H PUBLIC WORKS PE�RMIT P�oiicWarHSFee S <br /> ��� Totai Fee ' <br /> Lev Aoo�Fee PaiG 5 <br /> �.'a�. � Balanca0ue 5 <br /> ��� Print or Type Only <br /> ri �� `, <br /> � y� G�E y -.J /ii y �.��.- - ^ G��-� 9�L�: ,�t2-/.FV�" <br /> O x O Owner Mailing Address Gty Zip Phone <br /> � (q H 11 <br /> y z r (/-� '� �'✓ Phone <br /> � y d �PPlicant Mailing Address Ciry Zip <br /> �/� �� Describe Proaosed Work ��� �-T•� �- n 't `C""l �—� <br /> y�V �] <br /> zy� <br /> � Hy W� <br /> H / ' <br /> C� .7 C/� �-yx�r-t� � <br /> � �� Proiect Address(il known) %�� " <br /> � y y Atlach lour(4)copies ot plans fo�p�oposetl work� D�aw to scale ana note the�ollow�ng as appliwble: �� <br /> y �� • Properry Lines • Centerhne of street /^ <br /> � � • Outline and dimensions ot all ealsting and • Indicate Nonh V/� <br /> proposed structuras on the lot • Show any proposed grading changes <br /> • Existing and proposed utililles • Show measuremenis � <br /> �O NOT WRITE BELOW THIS LINE O <br /> FERMIT CONDITIONS <br /> +d r. 1.All calls for inspection shall be matle 24 hrs.in ativance-phone 259•$810. � <br /> �� 2.All work shall be pedormed in accordance wilh Ihis permit and current City of Everett Design and Cunstruction <br /> Slantlards and Specilications. � <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> !�."a ;� , <br /> «�,,,� ��.1 L2a l�i<7z�1- �.�G.t�,:.�t�;Gt�� ,�'y,c+eqa�� � <br /> c� <br /> �....� "/" � <br /> S 7-�/ ♦/� <br /> V♦ <br /> , � O <br /> .�xi I <br /> � � <br /> a <br /> ' ACKNOWLEDGEPAENT OF CONDITIONS <br /> �'! The untlersigned owner/applicant hereby tgrees ro hold and save harm- <br /> less Ihe City of Everett irom any and all claims lor damagas, cosis. <br /> expenses, or causes of action that may arise because of installatiun <br /> antl maintenance of Ihe improvemenl or other right-of-way use herelo <br /> a applied for and lurther agrees to remove same upon notice from ihe <br /> Approved for Canstruction ���e C�ry and to repWce public properry damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicanl Oale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED�WITHIN <br /> I@@q PUBLICWORKSDE°ARTIv1iNT 180 DAVS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> ;�r�'�� 3200 Cetlar Street BE DILIGENTLY PURSUED TO COMPLETION.TfIIS PERMIT MAY BE <br /> � ��'� EvarelC WA 99201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> phone:259�8810 PqOJECT OVER 90 DAYS DURATION. <br /> � <br />