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Date��� Public Works Pormlt• <br /> ApplicationFr,r BIdB.Dept.• � �71� __ <br /> P�)g1.lC �/C,RK;� PEF�II�IT PuElicWorksFce <br /> �� TotalFoe S <br /> Less Rppl Fae Faid .S <br /> Print or Type Only Balance Ouo S __ <br /> � J � �+� - y'o�� <br /> .�A�°10�o a ✓�°A/P,.e H��f �//`�7�0 ,E��u �bfi��r/�4 /�`vx:� ��3� ,.,2.%7_ <br /> Owner Mailing Address City Zip Phone <br /> SPl�ant�-- Mailir.g Address City Zip Phone <br /> DescribeProposedWork �� �L�/ ,� /A/�7 <br /> — W <br /> Prolect Addrecs(if known) __ � <br /> Atlach iow'(4)copies of plans tor proposed work-Draw to scale and note the follo�,ving as applicable: �i <br /> 6 Prcperty Lines O Centerline of street � <br /> � Outline and dimensions of all existing and O Inaicate Nor�h <br /> proposed struotures on the lot O Show any proposed grading changes <br /> O Existing and proposr�d utilities O Show measuremenis � <br /> �io <br /> DO NOT WRITE BELOW THIS�INE � <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall 6e made 24 hrs. in advance- phone?59•86'1 5. � <br /> 2. All work shall be performud in accordance�.vith this permit and current City ol Everett pesign and Construction <br /> Standa:ds and Specifications. <br /> 3. Call Location Underground Service 48 hrs.hefore yo�dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> _�� .� ��,�'/�ll� � <br /> � ,/���� Gr��/�"s . �, f_ <br /> /�G���JC� ��"'� �G,/ � <br /> y � <br /> � ,� r��'�,' �'U�f ,�T'-rC'//�=`�'�- �. <br /> , , ��//a:- <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 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 /> expenses, or causes of action ihat may arise because of installation <br /> and maintenance of �he improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice Oem the <br /> Approv=_tl fo:Construr.tion Date Ciry and to reFlace public property d•dmaged ihereby. <br /> FINAL IMSPEGTION Dzte ._ <br /> Approved as Consiructed Signature of Applicant Date <br /> everett PUBLIC WORKS�EPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Lverett,WA 98201 BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY 8E <br /> Phone:259-8815 �ANCELLED PY THE CITY UPON ANY STOPPAGE OF WOFK ON TH!S <br /> _� PROJECT OVER 90 DAYS DURATION. <br /> i <br /> �I <br /> � .. . . . .. ,S .' �: . <br />, . ,�j� �,,y7�� <br /> , �w �Y � ..e'�i .A!. .d`ai�'.A L.. k� ...`,..... a' <br /> ..,yf��AN r�'� .�� s�.�'i�b' .�e . n.. �+._. . .., . i+' - . , ^A� <br />