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; <br /> Date�`�"� . . a�m��wo,w.va�m,u G�� <br /> � eiaq oeo�.• — <br /> Application For \� <br /> PUBLIC WORKS PERM�T P°°"<`"°""°° <br /> Talal Fee s <br /> �-" �ess po0l Fee Pam S <br /> G <br /> O Zp— <br /> �'� � eaience Due S — <br /> Print or Type Only � � <br /> m c� c� <br /> ::' �w' w <br /> .�. <br /> -. u� <br /> o� <br /> Owner Mailing Atldress \ � o i� �_ ZiP Phone <br /> u5 <br /> �J O h 2 <br /> ��hGW Pe�ers 75Zfo � Olvmvi���Gw� �nbr� °1�02(c �7Co �(�7 <br /> Applicant ���v���lingAddresf Cily ZIP Phone <br /> �Ghc✓Wt�k <br /> Descri6e Proposed Work <br /> �I ���•p ��m�ae� 5(de�vcl k <br /> W <br /> ProlectA�dress�ilknownl �Z�I� (��.1hd' �V� _ � <br /> Attich lour(4)copies ol plans for proposed work- Drac�to scale and note tha followiny as apVlicable: � <br /> • Property lines • Centedine ol street � <br /> • Outline and dimensions o!all existinq and • Indicale Ncrth <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show mez;urements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig,TOLL FREE NUMBER 1•800-424•5555. � <br /> q• Goord�n�� �vorl� �V� �1� i��s�c�tor �n tl�e -r�eld � O <br /> j�n rl�s (a2,.bl�m2.v� 33� -7y-T�3 <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMFNT OF CONDITIONS <br /> The undersi9ned owner/applicant hereby agrees to hold and save harm� <br /> -- less Ihe Cdy o1 Everelt Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise bacause of installation . <br /> �N /�� � /�iL antl maintenance of the improvement or olher righFobway use here�o <br /> 1�� ���� applied for and lurther agrees to rer..ove same upon notice trom the i <br /> Approved lor Constructi Oate City and replace public erty damaged thereby. ,` <br /> ,y � <br /> �..-� ,S-,o .-sy - .c <br /> FINAL INSPECTION 'Date � Date <br /> Approved as ConsVucted Signature App ant <br /> �WORIc AUTHO IZED BY THIS PERMIT MUST BE STARTED N�ITHIN <br /> � PUBLICWORKSDEPARTMEN7 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � :200 Cetler Street OE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE C;ITY UPON ANY STOPPAGE OF WURK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />