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� <br /> ; � <br /> � Date 3 3 <br /> � Pu01ic Works Permit• �� ��� <br /> Application For BIEB.Dept� 7?,f��L� <br /> PUBLIC WORKS PERMIT Put'ICWorksFee <br /> TotalFee S �• V � <br /> Less ApP�Fca PaiE .S � � � <br /> Print or Type Only Balence Du¢ S ?—d. C� c� <br /> Es��-s <br /> �o�(R3 F�2er�,� oz��� � ci',e+,�d .c��crz�7l`- o?�s-5 �9�Y <br /> Owne Mailmg Address City 2ip Phone <br /> ��4�� <br /> Applicant Mailing Address City Zip Phone z <br /> 0 <br /> � c` � <br /> Describe Proposed Work Gc1Yi W�' �C¢� a � ),�iJ�Jr�Ci,o y �•���z,�0 n <br /> m <br /> v — .. <br /> 1 i7 <br /> W y = <br /> � m <br /> Project Address(if known) ,.� r-/(�� � n � <br /> ' cv <br /> m o <br /> Attach four(a)copies of plans for proposed work• Oraw to scale and note the lollowing as applicable: � � � <br /> � Property Lines • Centerline of sireet � � <br /> m <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes m � <br /> • Existing end proposed utilities • Show measuremenis � � Z <br /> DO NOT WRITE BELOW TNIS LINE <br /> rx <br /> PEfiMITCONDITIONS O ~ N <br /> < <br /> � <br /> 1. ca I,for in^,pection shall be made 24 hrs. in advance• phone 259•881 5. � o � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design antl Construction T ? <br /> Standards and Specifications 1 m <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. m N <br /> /• �f.JC 0.CCPS5 � �e 01+ ccLIP�f pwl.. ct i �L. 2 �'^ <br /> 7 '— �1 �w� O � cNn <br /> o v.. n 1 p` v� , / z c� <br /> \ -� r <br /> � • m <br /> a <br /> � <br /> � � <br /> x <br /> n <br /> z <br /> O � <br /> � <br /> a N <br /> Z <br /> 0 <br /> � <br /> .. <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIOIJS <br /> The undersic�ned owner/applicant hereby agrees to hold and save harm- <br /> � ��� less the City ol Everetl Irom any and all claims for damages, cosis, <br /> -�/—/—� expenses, or causes ol action that may arise because o� � tallation <br /> '�/ � �V'y/'�3 and maintenance of the � rovement or other ' use hereto <br /> pproved lor Cunstruction appli=d for and further s mov me u ' otice irom the <br /> � / Date City and to replace p ic p ed � <br />� ������L!-p�� � �� �"�/ �,. � _.. _ <br /> FINAL INSPECTION Date � � / �� `"`�G� <br /> Appruved as Conslrucled i§natu pplic4nt Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTl10RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY TfiE CITY UPON ANY STOPPAGE OF WORK OPJ TIiIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> ! � <br />