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Date�s7 � r�er�c wo,k�ac,m��i< / — G5�� <br /> AppliCatior� For amq.oePi.+� <br /> PUBLIC WORKS PERMIT PubllcWorksFeo <br /> TotalPee $ <br /> Less Appl Pee PaiE F <br /> Print or Type Only BalancoDuo s ��� <br /> � ��/�d.L.�����-I- ����J�Wi, IGIE�� ���� a�`�l �2� <br /> Owner Mai—Ting Address City Zip Phone <br /> ��I�- ����� 1-f�� 1 � n�� -��?, ������ <br /> Applicant Mailing�ress City Zip �:�one <br /> Describe Proposed Work (�7-I I�A-IC"'Y <br /> -- W <br /> Project Address(if known) � � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • ProGe�ty l°�es • Centerline of street � <br /> ! Oct�•ne; 3�d dirr.ensions of all existing and A Indicate North <br /> p�oposed struclures on he lot • Show any proposed g�a��,ng changes <br /> • Exi�t�^�n and proposed utilities • Show m?asurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERIv11T CONDITIONS �� <br /> r <br /> !. All calls(or inspection shall be made 24 hrs. in advance• phone 259•8815. �� <br /> 2. All work shall be performed in accordance with this permit and ^urrent City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. be(ore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> � <br /> � <br /> � <br /> O <br /> a <br /> �{� ACKNOWLEDGEMEIJT OF CONDITIOPJS <br /> �l( �-"' 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 and mainlenance of the improvement or other right-ohway use nereto <br /> Approved for C nstructira, Date applied for and further agrees to remove same upon notice from the <br /> �� City and to replace public properry damaged thereby. <br /> � ���� 1 1 ^ � ���/� <br /> FINALINSPECTION Date �\ )�Ma�,�1 � <br /> Approved as Conslructed Signature of Applicant ' � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. TH S PERMIT MAY BE <br /> Plione: 259-8815 CANCELLED BY THE CITY UPON AIJY STOPPAGE OF WORI<ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />