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���Z � �� ^ Public Works Permil• Q <br /> BIOB�DopL•�r /��V '�'� <br /> Application Fw <br /> PUB�I�; WORKS PERMIT PUE11cWorkaFea <br /> Totai Feo $ <br /> Less FpY�Fea Paitl g <br /> Balanco�ue $ <br /> Print or Type Only <br /> (�-cs-,� aa 3.z ��-��o-� � 9�zd I 3s y a671: <br /> Owner Mailing Address Ciry Zip Phone <br /> � �'e <br /> Applicant Mail�ng Address City Zip Phone <br /> Uescribe Proposed Work __3_�¢___�-�--��m��� <br /> � <br /> � <br /> Prolect Address(if known) � <br /> Attach four(4)copies oi plans tor proposed work- Draw ro scale and note the following as applicable: orw <br /> O Property Lines • CeNerline of street ♦�, <br /> ! Outline and dimensions ot all exisling and • Indicate North V� <br /> proposed structures on the lot • Show any proposed 9rading chan9es <br /> i Exis�ing and proposed utilities • Show measurements Y <br /> r�! <br /> UO NOT WRITE BELOW THIS LINE � � <br /> PERMITCONDITIONS � <br /> 1. All calls for inspection shall be made 24 hra in advance-phone 259•881.r,. � � <br /> 2. All work shall be performed in accordance with Ihis permit and cu«ent City of Everett Design and Construction <br /> Standards and Speciticationa <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUM6ER 1-800•42A-�555. � �, <br /> / lJ3l/� l�u�/'�/CS f��=2i�iT /�c �'C�JD� � <br /> ��/1���� ��C�T i�'" <br /> _, ,�,,� � ,�s- c� <br /> / � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thc undersigned owneUaFPlicant he'ehy ac�rees�o hold and save harrr <br /> Izss the City of Everett kom any and all claims for damages, costr, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement cr other righbof-way use herelo <br /> applied tor and furiher acrees to remove same upon notice from ihe <br /> Approved lor Conslruction Date City and to replace public property damaged Ihereby. � <br /> �INAL WSPECTION Dale <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMEf�T WORK AUTHONIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PEHMIT IS ISSUED AND THEREAFTER IS TG <br /> Everett WA 98207 BE DILIGENTLY PURSUED TO C0�IPLETION.THIS PERMIT N1AY BE <br /> Phone: 259-Fi815 CANCELLED BY THE CITI'UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 30 DAYS DURATION. <br /> l <br />