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,� <br /> '^I u ,�vi <br /> D��` � � / Pubhc Woik.Pcrmlt< i ` .� t: "� — <br /> � <br /> pldg.Ocpt• ' ._-- <br /> Applicalion For <br /> PUBLIC \IVORKS PERMIT PubTo�alFeefee S - <br /> Lass AOG�Fee Paitl S O <br /> � Balance Duo 5 ��� <br /> Print or Type Only <br /> �1LL C� �t�rr, l� I� ���r����n F� ����� �� .l ����l�-'�. <br /> Owner T Mailing Address City Zip Phone <br /> i�pp�i�;ynt MailingAddress Giry Zip Phone <br /> Describe Proposed Work ��� "��—r <br /> W <br /> Proiect Adc'ress(it kno•.vn; �: ` �'L�L.1LL6-a-+�,1L5—.� - � <br /> Attach four(4) copies of plans for proposed wor:;- Draw to scale and nole the following::�applicable: � <br /> • Property Lines . • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> propnsed structures on the lot • Stiow any proposed gradinA changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT INRITE EtELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed ir accordance with this permit and current City of Everett Design and Constructien <br /> Standards and Specifications. <br /> 3. Cs�l Location Underground Service 48 hrs. before yw �ig.TOL'_FREE DIUMBEP 1-800•424-5555. � <br /> � <br /> � <br /> � <br /> O <br /> a <br /> AGKNOWLEDGEMENT OF CONDITIONS <br /> i <br /> �L;➢� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, costs, <br /> e;<penses, or causes of action that may arise because of installation <br /> ,�� (/J / -7 , and maintenance of the improvement or other right-of-way use nerelo <br /> %.f' /' ��� / ��/ f applied for and turther agrees to remove same upon notice from the <br /> Approved for Constru� ion Date City and to replar.e public propr.rty damaged thereby. <br /> �--'j 7 ��"';� � . <br /> /-l/ �-C-L'`���� �/_J G_� . . .. <br /> . _ .,., �'�. . <br /> FIN L INSPECT N Date ' ' - � � � ��'� � ' �� <br /> Approved as Consiructed Signature of Applicant �Date <br /> WORK AUTHOfl17.ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ever�tt PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 C2dar Street BE DILIGENTLY PURSUED TO COMPL'cTION. THIS PERMIT t�tAY BE <br /> Everett,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON�fHIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />