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>,: <br /> .._. .,� <br /> �8�@ � / e/ Puelic Woda PermH• �����`" <br /> ApplicatlOn For eiaa.oeo�.• <br /> PUBLIC WORKS PERMIT P�biicWorknFee <br /> Tola1 Fee : <br /> Less Appl Fee P�10 S <br /> Print or Type Only Balance0ue s /��� ��'� <br /> / ' <br /> �2o �co�o� C� . Y��,�.� u �9/C7 ,�o� P� �� lSl�-�� G=���� �•t' � :�g�a.� --�/731$. <br /> Owner JMeiIingAddress ' City Zip Phone <br /> .J�i•v�Q_. <br /> Applicant Meiling Address City Zip Phone <br /> , '1 <br /> �' G r ' . / rL r � �l <br /> DeacribeProposed/Work �4 �`� �� •. W''�-ti /� ��•'����1 / c-�%' �1 ��t�fA <br /> �M Ln.T.rrt�- � �ri/C- S d- n •VI TS-.�V O__ -- C� �'1 S!C'�P W 4 �� • <br /> / <br /> ,. �.: . W <br /> Pro�ect Address(if known) �'���'� � �^� "� � <br /> Attach four(4)copies o1 plans lor proposed work- Draw to scale and note the following as applicable: � <br /> • Property Unes • Centerline of street � <br /> • Outline and dimensions ol all existing and • indicate North <br /> proposed structures an Ihe lot � Show any proposed grading changes <br /> • Existinq and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for Inspection shall be made 24 hrs. in advance• phone 259•8815. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Undarground Service 48 hrs.before you dig.TOLI FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> . The undersigned ownar/applicant hereby agrees to hold and save harm- <br /> J ,. less the Ciry of Everett irom any and all claims for dameges, costs, <br /> , / J � . expenses, or causes of action that may arise because of instellation <br /> /"j� , .� . � • . �//ICI� and maintenance ol the improvement or other right-oFway use nereto <br /> L.J"" '"y �' �f � applied lor and further agrees to remove same upon notice from the <br /> Approved lor Construction Dale City and to replace public property damaged thereby. <br /> _� � � • <br /> ������� �i� �� � / � � <br /> FI AL INSPECTION Date G,�u����"�'• -" ' <br /> Approved as Constructed SigriaturrDf Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY 7HI5 PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUEC TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYg DURATION. <br />