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. .. . .._- _ .. _. .__..'_. .�.-- .. _ . — '_. --r,.��.,�R,�--�:,u.�. .,�, . �. , , <br /> � y � <br /> Date��0 Z� <br /> Publm Works Permlt• --�—� <br /> Application For em9.oea�.•�����✓ <br /> PUBLIC WORKS PERMIT P���;�W���,F�a <br /> Tolal Fee s <br /> , Lase Appl.Fee Paid S i <br /> Print or Type Only ea�a��,o�, s <br /> � <br /> ��=.1, ��� , ��� r��� ��>,�� - ��� ��. � � «� �s� ��.,.�� � <br /> Owner Mai4ing Address City Zip Phone <br /> ��U'a).-vi_ � <br /> — 1 <br /> Appticant Mailing Address City 2ip Phone <br /> i- <br /> DeSCribe Proposed Work ��-�.--� -_ I <br /> — I <br /> � <br /> Project Address(if kncwn) ���U � � I <br /> Atlach four(4)copies of plans for proposed work- Draw to sca�e and note the tollowing as applicable: � � <br /> • Properry Lines • Cente�line of street � i <br /> • Outlino and dimensions of al�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 � I <br /> PERMIT CONDITIONS O � <br /> 1. All calis Icr inspection shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City ol Everett Deslgn and Construction <br /> Standarils and Specifications <br /> 3. Call Location Underground Service 48 hrs. before you di9.TOLL FREE NUMBER 1•800•424•5555. � � <br /> /L'C/ ��� ��F/'���1� /� f r� ' � � O <br /> ) G//-��.r- � <br /> //!�'�%� /'�c ' i'� f,�� <br /> ;�l . . _�'/�"�, �' <br /> V♦ I <br /> O <br /> a � <br /> � <br /> I <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agreea to hold and save ha�m- <br /> less ihe City of Everett Irom any and all claims lor dama9es, cosls, I <br /> expenses, or causes ol action ihat may arise because of installation � <br /> and mainlenance of ihe improvement or other righPol�way use hereto i <br /> Approved for Consiruction pa�e applied lor and lurther agrees to remove same upon notice from Ihe I <br /> City and lo replace public property damaged thereby. <br /> i <br /> FINAL INSPECTION Date I <br /> Approved as Constructed Si�nature ol Applicant Date � <br /> e•.erett PUELIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHIN I <br /> � 3"c00 Cedar Street 180 DAYS OF DAT� PERMIT IS IS3UED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PFOJECT OVER 90 DAYS DURATION. <br />