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�r-._-. � � .. ..-:+� <br /> � <br /> ��� � i <br /> p � ' Date`��7�9e v� �� Punhc wo�he Perm�t• <br /> ��� Applicalion For eiao oeo�.• 9���yy7 � � <br /> R�����yyy PUBLIC WORKS PERMIT P��to�Fee��� : <br /> ��� Lass RDY�Fee PaiC s <br /> � Print orType Only ea�a��eo�e s <br /> H <br /> M� . <br /> �N CG�''.� /J�asE� .�Si.z dE.eFrr �v6 SBu� a.td- F.�S� <br /> Owner MaiNng Address Cily Zip Phone <br /> �H w _,�q� <br /> C(p qpplicant Mailing Address City Zip Phone <br /> ar <br /> H q Describe Proposed Work 7 T ,f2ri... �Q �d��cv � i-�'r'r� ✓ � <br /> 6 GO <br /> � W <br /> ProjeclAddresslifknownl �7// fjCf��'!rr Q� � � � <br /> Attacn lour(4)copies of plans lor proposed work-Draw to scale and note ihe lollowing as applicable: � <br /> • Property lines • Centedine ot slreet � <br /> • OuHine and dimensions ot all ezisting antl • Intlicate North <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Existing and proDosed utilities • Show measuremenls � • <br /> P� <br /> DO NOT WRITE BELOW THIS LINE O � <br /> � PERMIT CON DITIONS <br /> '�' 1.All calls for inspection shell be made 24 hrs.in ativance•phone 259•8810. ^ <br /> 2.Atl wo�k shall be pertormed in accordance with this permit and current City ol Everett Design and Consiruction � <br /> ' ' Stendards end Specifieations. <br /> � E 3.Catl Lxation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> �� N o pua��c. I�l o�.s ��<i ��� ��v 0 ` <br /> 1 ` �-'�`� V� <br /> _� ' �/�ega � <br /> _� a <br /> _� <br /> ' ' ACKNOWLEDGEMENTOFCONDITIONS ' <br /> � The untlersigned owneNapplicanl hereby agrees lo hold antl save harm• �. <br /> less the City ol Everett Irom any and all claims lor damages. costs. <br /> 1�' expenses, or causes ol action that may arise because of installalion <br /> _ and maintenance ol the improvement or other rig�t-ol•way use hereto <br /> applied lor and turiher agrees to remove same upon notice Irom ine , <br /> -- Approvetl for Construction Date City and to replace public pwperty damaged t�ereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Da1e <br /> everett PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> O 3200CederStreet 1B0 �AVS OF DATE PERMiT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA98201 BE DILIGENTLY PURSUEO TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:259�8870 CANCELLED BY TI{E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> � <br /> i <br /> i <br /> If <br />