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Date "��"�3 Pu�licWorksPermita$3 80 <br /> Application For eiae�oeo�.+ <br /> PUBUC WORKS PERMIT PUDI1cV7orkaFea <br /> TolelFee � ��•O O <br /> less AOP�Fea PaIU s � <br /> Print or Type Only �/j� Be�a�=a o�a S a o•o c� �"; <br /> � <br /> v/ S'T«%��✓ /%O r� ��ig�'� EEl/�77 �t'd�/ �SY-�3�' <br /> Owner Mailing Address it�Zi� Phone <br /> S��e <br /> Applicant Maiiing Address City Zip Phone <br /> Describe Propos@d Work �������� ���fJLf{— V ( � `'�� � V <br /> �.�.�1�ti� ,r�, �J�z____�-,�,lti�T Y�-� ����� <br /> W <br /> Project Address(if known) � – � <br /> Altach four(4)copies of plans for proposed work- Draw to scale and note the tollowing as applica6le: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing a�d proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t, All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City oF Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> I�• �=nypl'C.T 10.� �s�ll �oG �'G `N���.Y WNtn WU��Ic It 6�rt.�}� <br /> 1 �� O <br /> � �e.�e�..�...�. i-�re. o� ensl-�..� r...�b cr....� �- <br /> -�7PeoT rew.,7.,� �s rrS�n�rt�(, �r...e,...w� c�.o .. ^ � <br /> �'1 io VJC �.�a5�a��r.X �U " �'h1� • T-'�!1 4! iGCu�.nwe...�Yt✓ <br /> �1-�.�..r\ -11.t C'_Aas-T...� q�.o.` b` �e ,,..o., r„Y a..�Y ��v�lo.1l� � <br /> �t P�c�e��Y �-..� ... be Ner' ,ob (,6�ne,..JL�lL. .... �\� b e „�.t, ro�.� O <br /> (�lra�/ !'..�1t+eLt"rA.nC � 1."� 1 �� �O� J\1b51w....� �{\��� �oNN� � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm• <br /> less the City ol Everett trom any and all claims for damages, custs, <br /> ��7 _��3 expenses, or causes ot action that may arise because ot inatallation <br /> and maintenance of the improvement or other right•of•way use herelo <br /> appl' r and further agre s to remove same upon notice Irom the <br /> A �oved for Const•uction Date Cit and o re lace public operty damaged thereby. � <br /> �� / �'`2'�� � � <br /> F C SPECTION Date • _ 7� <br /> Approved as Constructed iy ture of Applica t Date <br /> everett PUBLIC WORKS DEPARTMENT �^10RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGE�TLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY !HE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> � Phone: 259•8815 PROJECT OVEF 90 DAYS DURATION. — <br />