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i <br /> oe�e o-�3 j s <br /> 9i � � PuElicWorkePumll� �� ,� <br /> AppllCatlon For Biao.Deo�.r <br /> PUBLIC WORKS PERMIT P�����W�^�F�� ,�a �, o <br /> Tol�l Fee <br /> Loae A00�fee Paitl f � <br /> Pflllt O�Typf O�IIy . Belence Uue S��' U a <br /> ds5��� <br /> OAvf� �*ANSaa /os-y A�oRtNP���c �R � �T. 9$a-�' 3 � Si- .�� 5� <br /> Owner Maiiing AAdress City Zip Phone <br /> ��M � <br /> Applicant Mailing Address City Zip Phone <br /> Descrlbe Proposed Work 1� ��"S S)NA�-Q- F AM��y �'�-S i 0<!v c� . <br /> 1 <br /> Project Address(if kno•Hn) � 33 ' 3 0� S 0.v� R�J w �V � � � <br /> { � <br /> Attach four�4)copies of plens lor proposed work-Draw to scale and note the following as applicable: � ! <br /> • Property Lines • Centerline of street � � <br /> • Outline 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 /> DU NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells tor inspection shall oe mede 24 hrs in advance• phone 259•8815. � <br /> 2. All work shell be performed tn accordence with this permit and wrrent City of Everett Design and Conslruction <br /> Standards and Specifications <br /> 3. Cell Location Underground Servico 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �� O <br /> �,� w�� � H <br /> � � � , � � � � <br /> � �� � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersipned owner/applicanl hereby ayrees to hcid and save harm- <br /> less Ihe Cily ol Evarett trom any and all cleims for damages, costa <br /> �_ expenses, or cauees of action that may arise because ot installetion <br /> �Q�J¢� and maintonance of Ihe improvemsnt or othar righFohway use hereto <br /> applied for and lurther agrees to remove same upon notice from the <br /> A roved for Construction Date City and to repiace public roperty damaged thereby. <br /> FINAL INSPECTION Date ` � � (/""�'Y\ /� 'a-r'- D 3 <br /> Approved as Constructed ignature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TNIS PERMIT MUST BE START.ED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUEC TO COMPLETION.THIS PER�11T MAY BE <br /> Phone:259•8815 CANCELLED BY THE CITY UFON ANY STOPPA�E OF WOHK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. • <br />