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I <br /> '� I(i1 � I ��s=.��i � <br /> Date��� Pub�ic WO�µs Per I a <br /> ` �"rs /s� �s <br /> Application For eme�Deoi i ��—` I <br /> PU��IC WORKS PERNiIT Pu0TolalfaeFee 5 <br /> i�ss noc�Foa P���a 5 <br /> Ba'ance0uo $ <br /> Print or Type Only <br /> J �l" I �1r-.a—i) ��J � � �L /1/l� :C�' ��LI--L—L�Z %��Q� /�n J � ��� <br /> Owner Mai{ing Address City Zip Phone <br /> �� <br /> Applicant Mailing Addres=_ City Zip Phone <br /> Descri6e Proposed Work �� <br /> v <br /> ' C ) � <br /> � <br /> Project Address(il known) � <br /> Attach tour(4)copies oi plans for proposed work- Draw to scale and note lhe lollowing as applicable: •� <br /> • Property Lines • Centerline ol slreet ♦� <br /> • Outline and dimensions of all existing and • Indirate Norih V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE B�LOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. illl calis lor inspection shall be made 2�1 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be Nerformed in acwrdance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•,ri5$5. q <br /> 6 <br /> '�. �-���� C�Z��Y�'[��C �r���� CrG���� I��-/�' �cc7.5' � <br /> / <br /> p�� <br /> Yd i <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF COhUITIONS <br /> The undersigned ownedapplicant hereby agrees�o hold and save harm� <br /> — less Ihe City of Everet[ from any and all claims tor damages, costs, <br /> � � � expenses, or causes of 2ction thal may arise because of installation <br /> and m�inlenance of lhe improvement or other right�of-way use hcreto <br /> � N' �f ���� aoplied for and furiher aSrees to remove same upon notice from th� <br /> Appr.oved ibr Co�ns)r c.ion � �a�e y to repl ce public property damaged ihereby. <br /> �� � ����� <br /> � / i <br /> FINAL INSPECTIOIJ �a�e ' I � �—�'S <br /> Approved as Constructed Si n ture t A pli an4 Dato <br /> WORK AUTHORIZED BY THIS� IT MUST BE STP.RTED WITfiIN <br /> evere[t PUBLIC WORKS DEPARTMENT 180 DAYS GF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> � 3200 Cedar Street EE DILIGENTLY PURSUED TO COMPLETION. THIS PERh11T ,v1AV BE <br /> Euen��t,WA 982U7 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURAT!ON. <br />