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-`r 1 <br /> I <br /> Date��o� <br /> Pu�iicWohsPermi • `�� 22 � � <br /> aiao.oaa�.• <br />� Application For <br /> PUBLIC WORKS PERMIT PubIi�WO�kaFae <br /> Totel Fae S �v� � � <br /> Less Appl Fea PeIC S <br /> � Print or Type Only B=�a�=a o�a s a �• C7J �1 <br /> C 14�eeNcc. �o �e�es �7�/.� c G�++�1 9��10 / �s� - i22i <br /> Owner Mailing Address City Zip Phone <br /> ��K�A �� 11� �,�x(.s �yi6 ��r�7f"F��e. 9��/ �.s'�- y��/ <br /> Applicent Maiiing Address City 2ip Phone <br /> Describe Proposed Work �'r)� T 1 I@V C / G' RA -r`i e <br /> v <br /> W <br /> Prolect Address(if known) A'�"' � <br /> Attech four(4)copies of pians for proposed work• Draw to scale and note lhe tollowing as app�icabie: � <br /> • Property Lines � Centerline of street � <br /> • Outiine and dimensions of ail existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDIfIONS <br /> 1. All calls for Inspection shell be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in eccordence with this permft and current City ot Everetl Design end Conslruction <br /> Standards and Specifications. <br /> 3. Call Locetion Underground Service 4B hrs. before you dig.TOLL FREE NUMBER 1•SOO•424•5555. � <br /> `�. Exis-4- � �� a IIP� � �a�e. is �, o � -� b� �: 1 �e�e�� O <br /> � <br /> � <br /> � <br /> , <br /> a <br /> ACKNOWLEDGEMENT OF CONOITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save herm- <br /> �,r� less the City of Everett from any and a�i ctaims lor demeges, costs, <br /> expenses, or causes of action that may arise because of Inatallation <br /> JC` ?y,�,3 and maintenance ol the improvement or other righ4of-wey use hereto <br /> applied for and fuAher agrees to remove same upon notice Irom the <br /> roved for Construction Date City and t/o r�lace publi roperty dameged thereby. <br /> � �`� i� � _��' ��;�j��G'� �= �3- �3 � <br /> FINAL INSPECTION � Dafe <br /> Approved as Conslructr.d Signature of Applicant Dete <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBIIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 3ft201 CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•Bf•15 pROJECT OVER 90 DAYS DURATION. <br /> J <br /> , .� <br />