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; <br /> Date ����,�.�,,�,�:re�.,,�, , <br /> Applicalioo For �'�n �c:�� _ <br /> Pl1B�IC WORKS PERMIT P����=W���9F80 <br /> Total Fea �— _ <br /> Less 4noL Fee Vaio $ <br /> Print or Type Only Ba:_,^_°°°e s <br /> .STc?lE ,E�/JO.�� 243Z dacK.:�� �cf82,L,-77- ��Z�3 .�53—c�(olo}� <br /> Owner Mailing Address Ciry Zip Phone <br /> �.�� -����.�� �EYzy ,���� �9 ;�az�- ��+zt� :�¢�-%�, <br /> Applicant Mailing AAdress City 2ip Fhom.� <br /> Describe Proposed Work �S7vay-� Z3 J� �� �.0� � O� ��7i,4��� <br /> j�.tJ(f�.�. ��-�tiliL.Y /Ger — <br /> Prcjecl Address(if known� "!f�-2�Z � AGiC:/�/'�w',� � <br /> Attach lour(4)copies of plans for proposed worh- Qraw to sca!o and note iGe following as applicable: � <br /> • Property Lines • Centerlinc ol sireet � <br /> • Oulline and dimensions of all existing and • Indica;e North <br /> proposed siructures on the lot a Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LItvE ♦` <br /> PERM!TCONDITIONS l ! <br /> v <br /> 1. All calls for inspectiort shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2 All work shall be performed in accordai.. e wrth this permit antl current City of Everett Design and Construction <br /> Standards and Specifica�ions. <br /> 3. C�II Location Underground Service 48 hrs. belor�you di9.TOLL FREE NUMBER 1•800•424-5555. � <br /> � <br /> �� �'' i'��/�'/�/�. � �� � • �/ � <br /> I � ,' � <br /> :i � <br /> �/ ` '/ // � <br /> �,�� � {� ��i.7^ <br /> { � , <br /> ���;, � � � <br /> , <br /> a <br /> c � <br /> �� �Q� � ACKNOWLEDGE61ENT OF CONDITIONS <br /> The undersigned owne:/applicani hereby agrees to hold and save harm� <br /> less the City of Everett Irnm any antl 211 claims for damages. costs. <br /> expenses, or causes ol action that may arise because ol instai!at�on <br /> and maintenance of ihe improvemenl or other ri�hl-o�-way use hereto <br /> applied lor and luriher agrer.s to remove same upon notice Irom thc <br /> Approved for Construction Date City and to repiace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicant p��� <br /> �verctt PUBLIC WORKS DEPAflTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED ANC THEREAFTEfi IS TO <br /> Everett, WA 90201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B'c <br /> � Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />