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PUUIic WorMSPerm�l * <br /> ,�'�S /L, <br /> Date �� � �-r <br /> eiao.ooa�+ <br /> ApPlicalion For <br /> P E R M I T P�ouc wo�ks Fee S <br /> pUBLIC V'i/ORKS TotalFee <br /> � Loss ApP�Fae PaiO g �� <br /> Balance�ue S <br /> Print or Type Only <br /> ���G�—o TI � �� ZS�� #Z E�Ere.�� 9%� '3 39•�Z-z 93 <br /> Owner Mailmg Address <br /> Ci,Y ZiP Phone <br /> 5�-�-. " City Zip Phone <br /> Applicnn� Mailing Address <br /> I c1E !O f1-i c U h �Jti lM � S 1 Z /L <br /> Describe Proposed Work `n �' � _ <br /> /-�.C'c'-� ' �"f.d C".�-� .UOC<> . � <br /> Z� o A- � <br /> Project Address(it known) !� <br /> Attach tour(4�copies of plans tor proposed work- Draw to scale and note�CQo11ev�ine of street able: _ v <br /> • Property Lines • Indicate Norlh <br /> V� <br /> • OuUine and dimensions of all existing and � Show any proposed gradin9 changes <br /> proposed structures on the lot � Shcw measurements /� <br /> • Existing and proposed utilities W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls tor inspPdion shall be made 24 hrs. in adv&nce- phone 2S9•881 5. <br /> 2. All work shall be pertormed in accordance with this permi: and currenl City of Everett Design and Cunstruction � <br /> Standards and Specifications. � �- <br /> 3. Call Lccation Underground Service 48 hrs. betore you dig.TOLI FREE NUMBER 1•500-424•555 . F <br /> r, <br /> r. <br /> � .. <br /> � H '- <br /> tlr U <br /> � r. <br /> � ,� <br /> � � F <br /> y � <br /> C7 <br /> r'J : <br /> C <br /> ACKNOWLEDGEMENT OF GONDITIONS � :� <br /> `� � <br /> ?I:e undersi9ned o�.vner/apFlicant hereby agrees to hold and save harm� <br /> — less ihe City of Everelt irom any and all Gaims lor damages, cosls, � ` <br /> expenses, or causes of action thal may arise because of installation <br /> J/ r and maintenance o1 tha improvement or other right-of-way use herelo '�� <br /> ���rd ivl �--� � "r� applied lor and lurther agrees to remove same upon nolice irom the �= <br /> ApV�oved for Constructian ',� <br /> �T Date City and �o replace public property damaged ihereby. � : <br /> � �� � . <br /> .� ����<-� r--d�- ,� � � � z, � <br /> � Date � Date <br /> AL NSPECTI N Signature of Applicant � ' <br /> Approved as Constructed y�ORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENlLY PURSUED TO COMPL[TION. TH!5 PERMIT MAY BE <br /> � Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPFr'GE OF WORK ON THIS <br /> phone: 259�Q815 PROJECT OVER 90 DA'!S DURATION. <br />