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�t.� � ����j�' <br />. Date11�9`� <br />PUBLIC <br />Print or Type Only <br />1 <br />� <br />lication For <br />RKS <br />� �O <br />_ .• <br />PERMIT <br />8 O 1!'f O 1!I N O O 1� <br />o_r � o.p e�i vi o oi <br />Na�.� tiM MM M ~ <br />LC �-I M <br />1Q�,f1�'� �I� <br />/ <br />Pu�lic Wads Per + ��_ � <br />Bldp. DeO�� • � � -. <br />Pu�hcWa�k6feo S <br />Totel Fee <br />Less AOP�- Fee Paia S �� <br />Baiance Ooe S <br />.� <br />Appiicant Mailing Address City Zip Phone <br />Project Address (if known) <br />U <br />• Attach lour (4) copies of plans for proposed work • Draw to scale and note Ihe lollowing as applicable: <br />� • Property Lines • Centerline of street <br />! • Outline and dimensions of all exisling and • indicate North <br />i� � proposed structures on Ihe lot • Show any proposed grading changes <br />�. _ • Existing and proposed utilities • Show measurements <br />Approved for <br />FINAL INSPI <br />Approved as <br />everett <br />e <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with this permil and current City of Everett Design and Construction <br />Standerds and Specificetions. <br />3. Call Location Undergrou�d Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />��vcv�� ,s.�,�� �6 �� 6.���1'� "�. �.--�/�e��� <br />� �,Z�o� `;,f � ,�uv� ���� � �a�t�� <br />��,�f .�� �,���� .�„f s.�.� <br />PUBLIC WORKS DEP�RTMENT <br />3200 Ceder S!reet <br />Everelt, WA 98201 <br />Phone: 259•8810 <br />�f /3 -�� <br />W <br />H <br />� <br />� <br />0 <br />�"' <br />� <br />� <br />a <br />ACKNOWLEOGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less ihe Ciry of Everett irom any and all claims lor damages, cosis. <br />expenses, or causes of action that may arise 6ecause of installation <br />and maintenance ol ihe improvement or other righl-ol-way use hereto <br />applied for and further agrees lo remove same upon noBce Irom Ihe <br />City and to replace public pwperty damaged thereby. <br />�7 <br />L��.�, � 1,.2 i ,%1� � 8 <br />Sig ure ol Applicant • Dale <br />WORK AUTNORIZ[D BY THIS PERM�T MUST BE STARTED WITHIN <br />780 DAYS OF D�TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />