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,� <br /> .,� <br /> DatO 11 15/8 3 v�or�wo�ks aa�m��_ <br /> Application For <br /> eiaa ooac: 83/12� <br /> PUBLIC WORKS PER111� iT 'ubTo�alFeeFee 5 �- <br /> Less AOP�.Fna Paltl 5 �, UC�- <br /> Balance Oue <br /> Print or Type Only <br /> �'%a 77 <br /> Duiardin Development PO Box 5'��R Fverett R'A 98206 334- 5018 <br /> Owner Mailing Address City Zip Phone <br /> Same <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposedWark cin�ja f�mil� —acir�anrr <br /> ! EAST � <br /> ProjectAddress(if known) � �t„e.,,_�3-3-3- T*+rorr-i�r � <br /> Atlach four(4)copies of plans for proposed work- Draw to scale and nole ihe tollowing as cpPlicable: v <br /> O Property Lines • Centerline of street ♦� <br /> • Oulline and dimensions of all existing and • Indicate North V� <br /> proposed struciures on�he lo� • Show any proposed grading changes <br /> • Existing and proposed utilitiss • Show measurements � , <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERNIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be p��rformed in accordance with Ihis permit and current Ciry of E�ierelt Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREC- NUMBER 1•800•424-5555. � <br /> 4. Per approveG �lans signed .[2/7/8� and preliminary plat app:oval 6-79. O <br /> � <br /> V/ <br /> 0^ <br /> ��e1� <br /> �CI:NOINLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/applicant hnreby agrees to hold and save harm� <br /> less the City ot Everett Irom any end all claims lor damages. costs, <br /> expenses, or causes ol adion that may arise because of in.;tallation <br /> � �n � and maintenance of lhe improvement or other right-ot�way use hereto <br /> applied for and turther agrees to remove sam: upon notice Irom lhe <br /> Ap�ved or onsiruc �on ate City and to�ce public prop y amaged ihereby. <br /> �� � <br /> !/�- � oL—.�_ �_ ZG_ <br /> ' FINAL INS OT O Date � <br /> Approved as Cons ructed Si�nat�re ol Applicant Date <br /> everelt PUBLIC WORKS DEPARTMENT VJORK AUTHORIZED BY IS P RMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Strc�t 180 DA'f5 OF DATE P •RMIT ISSUE� AND THEREAFTER IS TO <br /> G.eratt,WA 98201 BE DILIGENTLY PURS E O COMPLETION. THIS PEFMIT MAY BE <br /> Phune: 259-8815 CANCELLEO�Y THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJECT OVEH 90 DAYS DURATION. <br /> ., <br /> �- <br /> c <br />