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�8�@�� Publlc Works Permll• ��_�0 <br /> Application For ema.oeo�.• <br /> PUBLI� WORKS PERMIT PuoneWork�Fee 1-- 9� 0 <br /> Tolsl Fee S <br /> �esf ROC�Fea PeIE S _ <br /> Pfl�lt Of TypB Orlly BelanceDue S 2D ob <br /> �s 3�6,6 <br /> ��f�'��r1 �D. 6�X /X3z Idf�f�r� 9 O 6 �?.�9.d�A/ <br /> Owner MaiNng Address City Zip Phone <br /> _.S/9/��� <br /> 4pplicant Maiiing Address City Zip Phone <br /> Deacribo Proposed Work _ n F��d�x x Aoorr�c,�- <br /> /� W <br /> Project Addreas(if known) � 3OZ lJ �/%/1�� � <br /> Attach four(4)copies of plans tor proposed work• D�aw to scaie antl noto the fol�owing as applicable: � <br /> � Property Lines • Centerline of st�eet � <br /> • Outllne and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. AII calls lor inspection shell be made 24 his in advance- phone 259•8815. � <br /> 2. All work shall be peMormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standerds and SpeciHcationa <br /> 3. Call Locetion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> T.cii.i' PA•CL ii��r /J.e�.'.a.vGE.�iEroi iJ' Af�i�,Pavc�p �o To T.s'E <br /> GO�ENTidG Fa� l7EvE�oi'.,oE�vT oF T.v� /.�'y'� 5-7- O . <br /> IPiG.�T Or Ld4j/ -f'S �f L�iEic' ��ai- CCo,F.�•rL'o�C . <br /> 4. QEsiu�i� 'P�."'lP�l>c�'�.1EiuT o� S�t�. S�-u,t� ��/� � <br /> w �� (,,, V� <br /> , O <br /> ,�/� ��,�,�/����'n �� a <br /> n/'l�sP�t / J ��-,Oni <br /> P � (A� /� <br /> �V ��c �D//✓ Go� .c Ps� r�i l��� , i,Ue,/ C <br /> �� (f `'�" � J )/ �" (ACKNOWLEDGEN�NT OF CO�IC�� /J// <br /> j �vt 5� � � � i�;�� <br /> (� � The undersigned owner/applicant hereby agrees to holpynQ save � <br /> �J less the City of Everett irom any and all claims lor damages, costs, <br /> �...—:!c�� � exPenses, or causes of action that may arise because of installation <br /> � ��5-�� and maintenance of the improvement or other right-of•way use hereto <br /> � app�ied for and further agrees to remove same upon notice from the <br /> !lppro ed�p Cy atruction Date (;ity and replace publi perty damaged thereby. <br /> �� <br /> FINAL INSPECTION Date ' y � <br /> Approved es Constructed Signatur of Ap I cant Date <br /> everett PUBLIC WORKS DEPARTMENT WOR AUThIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eveiett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEF��AIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />