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- -, <br /> �ate -�� PUEIic Worka Pormil s O � �U 3 <br /> Applicalion For emy.oao�.. �`��/ �o� <br /> PUBi.IC WORKS PERMIT Pu�ToelFoeFea $ �, o 0 <br /> ��� ' <br /> Loss AOP�Fee PaiO $ <br /> Oaian<e Oue $a U . d C� <br /> Print or Type Only 6,g/�, <br /> DiX�e �• �un� 6 er� /�v-� r�I,�,(- /�..F' F/�rrT �t�r�� .�!��-f/�� <br /> Owner Mailing Address Cily Zip Phone <br /> 1�rt�(/ <br /> Applicant Mailing Address City Zip Phone o <br /> . l �,y,/A/�' �, � <br /> Describe Proposed Work ���/ !���S� — `v"`, 1� •C. )�� m <br /> —�A/.t � — ` • <br /> -i '*1 <br /> � .-� � <br /> N 2 <br /> ,,.p � m <br /> Project Address Iil known) � �� �� � '� � G�-��'�`� � � <br /> m o <br /> . � <br /> Attach four(4)copies of plans lor proposed work• Oraw to scale and note the lollowing as applicable; � � c <br /> v <br /> • Properry Lines • Centerline of sVeet � � Z <br /> • O�Iline and dlmensions of all exi,ting and • Indicate North = .� <br /> proposed structuros on the lot • Show any proposed grading changes m <br /> • Existing and proposed utilities • Show measurements /� 'c ` <br /> W n -+ <br /> — DO NOT WRITE BELO THIS LINE � � <br /> -� tn <br /> PERMIT CONDITIONS j -n <br /> 1. All calis for insnection shall be maAe 2a hrs. in advance-phone 259•881 5. ^ � y <br /> 2. All work sholi be pei�onned in accordance with this permit and current Ciry of Everett Design and Construction �� � m <br /> Slandards pnd Sp�ciflcations. m � <br /> 3. Call Locmi�n Underpmund Snrvice d6 hrs. belore you dig.TOLL FREE NUMBER 1-S.00•424•5555. � N <br /> or <br /> � t-� m <br /> � N <br /> y <br /> zn <br /> —1 r <br /> ' � • m <br /> n <br /> z <br /> N � <br /> _ <br /> a <br /> z <br /> O � <br /> � <br /> a N <br /> Z <br /> 0 <br /> � <br /> � <br /> m <br /> ACKNOWLEDGEAIENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> - �--- less the City of Everett irom any and all claims lor damages, costs, <br /> � � � --— �����? � expense-, or causes of action that m2v arise because ol installation <br /> �� �'-�_. �_�� and maintenanr,e of the improvement or other right-ohway use hereto <br /> ` applied for and further agrees to remove same upon notice from the <br /> Approved for Construction � Date City and to replace public property damaged Ihereby. <br /> �� ��-��i /-f"� <br /> ��'A�cr�- Date <br /> Approved as Construcled Signature of Applicant Date <br /> � everelt PUBLIC WOFKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE S�i 4RTE0 WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THERt4FTER IS TO <br /> � 3200 Cedar Siree� BE DILIGENTLY PURSUED TO COMPLETION. THIS PERf 11T MAY BE <br /> Everetl,VJA 98201 CANCF.LLED BY THE CITY UPON ANY STOPPAGE OF WOR�:ON 7HIS <br /> Phone: 259�8815 PRCJECT OVER 90 DAYS DURATION. <br /> 1 <br />