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-, - - -�--,�_,�.,--�, _. _-- -- -- . - .�--- ._�__�— <br /> r1 �'� <br /> �etB�`'/'��.��.!/�_��L , � Pu�l¢WorAa Permit• <br /> " Application For BiEg Dept• _�+�,�.��SS �; <br /> PUBLIC WORKS PERMIT PubTotnlReeFee s — <br /> LeasApo�-FeePa�e S <br /> Balantt Due f <br /> Print cr Type Only <br /> i , <br /> � ��� � �aP ,,� �i �� �or , �'; r_ h'.ye i�Jc� �5f� y6o� <br /> Owne MaiNng Address City 2ip Phone <br /> , SQ� <br /> Applicant Mailing Address City Zip Phone <br /> Deacribe Proposed Work Gn .n ���� i,4�, )(r yA-rN Pd�" <br /> ) 1 W <br /> Project Address�il known) �Z��� �J�'�U�yl �y JQ' � <br /> Attach four(4)copfes ol plans for proposed work• Draw to scale and note the following as applicabie: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> � Exlsting end proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All calis lor inspection shall be mede 24 hra fn advance•phone 259$810. � <br /> 2.All work ehall be peAomied in accordance with this permit and current City of Everett Design end Conetruction <br /> Stendarde and Speciiicationa. <br /> 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 7•800-42M5555. � <br /> P�,�< «�.�-. � �,,�; �r�if,���, �- �.r Q <br /> � ,�> �<<.�:.���. � <br /> ������ <br /> � <br /> 0 � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant he�eby agrees to hold and save harm• <br /> less �he Cily of Everett from any and all olaims lor damages, costs. <br /> ezpenses, or causes of action that may arise bec2use of instaflation <br /> and maintenance ot ihe improvement or other right�ol�way use herelo <br /> applied for and further agrees to remove same upon notice from the <br /> Approved lor Construction �a�e � City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> � 3200CederStreet BE DILIGEN7LY PIIRSUED TO COMPLETION. THIS PERMIT MAY BE <br /> I Everett,WA 98201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />