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r <br /> � __ _-� <br /> �8�@��1 Y '�� �✓'�� p�plic Workt Pormil,r �� <br /> L <br /> Applicat�on For aieo.oeu�..o� <br /> PUBLIC WORKS PERMIT Pu�IlcWorksFee <br /> Tot�l Fee s <br /> , Laes ADp�Fee PaIC S <br /> Baience Due = <br /> Print or Type Only <br /> �ol'L � Gi (G�C f� �X 3� T! a�Y�Q2l ��3/� 77-ao�� <br /> Owner Mailing Address City Zip Phone <br /> P�r�� �s;�r 3�/6 �i�.�v�- �� .t�.�,��-- ���� �s-�—y��� <br /> Applicent Mailing Address City Zip Phone <br /> Deacribe Propoaed Work ��r� ��.SG <br /> I Pro�ect Addreas(if known) � y T V � <br /> � <br /> Attach four(4)copies ot plans lor propoead work• Draw to scale and note the following as applicable: � <br /> • Proparty Linea • Centerline o�street � <br /> •Outline and dlmenaione of all existing and • Indlcate North <br /> proposed structurea on the lot � 5how any proDosed grading changes <br /> • Exiating and proposed utilitiea • Show measurements � <br /> I DO NOT WRITE BELOW TNIS LINE <br />� PERMIT CONDITIONS O <br /> 1. All calls for inspection shell be made 24 hra in advance•phone 259-887 5. � <br /> 2. All work shell be periormed in accordence with this permit end current City of Everett Design and Conatruction <br /> Standards and Speci(Icationa <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLI PREE NUMBER 1-800•424•5585. � <br /> I '! O <br /> � � � n � � � <br /> � �� � �� � , � <br /> 1 �� ��;� � a <br /> � <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to huld and save herm- <br /> less the City of Everett irom any and all claims tor demages, costs, <br /> expenses, or ceuses of action that may arise because of Instelletion <br /> and maintenence of the improvemxnt o�other righPof-way use hereto <br /> applied lor and lurther agrees to remove sema upon notice irom the <br /> Approved for Conatruction Date City and to replace public property demaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CadarStreet 180 DAYS OF DATE PERMIT IS ISSI�ED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TC� COMPLETION. THI5 PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> t <br /> � I_. _ ._.._ <br /> � <br />