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�8t@;�� PUEucWorNePermit• �� _J�" <br /> 91dp.oep�.. <br /> Applicetion For <br /> PUBLIC WORKS PERMIT P°°:o;;.ee°°. _ <br /> Leae Ppo�Fee Psie $ sD <br /> Balence Dua S/��- <br /> Print or Type Only - <br /> /l1Er�t/�oo �T Li�'/G,�c� �O '��:C'.r'D.f' �r/E.EL��l 9�9�.� — <br /> Owner Mailing Address City Zip Phone <br /> �l.��s�.c� �ii.r�.y�-G �-�,�r�s .«�' 6s9- �0.�7" <br /> Applicant Mailing Address Cit Zip Phone <br /> Describe Proposed Work T•r/�S'r•9�G �'r y C'qsc�./ �9si�/S <br /> f.�1> .G7P�i�cJ !i-t�r�S cfJ.r��v�cii.r/lr ic� f'li,ac� C <br /> .d/?%i�rl/YiE' S'TE"�J. <br /> W <br /> Project Address(if known� �� '� �L�S 1�,P � <br /> Attach four(4)copies of plans for propor�,c. '� �,. :w to scale and note the following as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outline and dimensions ot aJ r��ara,;t�nd • Indicate North <br /> proposed structures on the lot � Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT GONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance•phone 259•8815. � <br /> 2. Ali work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> StandercJs and Specilicetiona <br /> � 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1�800•424•5555. � <br /> 1� Co�v.si,evcT f��,e fJ�T,e�'.�,�E,o SK�-�c�,�/ O <br /> 09/OB/86 9:574�f OOOAN1836 � <br /> / � <br /> DPT.20 f159.50 <br /> CHECf; 5159.50 O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm• <br /> � �� �� less the City ol EvereO Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of inslallation <br /> _ / C� p �6 and maintenance of the improvement or other riyht-ol�way use hereto <br /> t�e��?� � 0 applied for and lurther agrees to remov�� same upon notice from the <br /> � Appro ction � City and to replace public pr perty damaged thereby. <br /> . � � <br /> / / �rC�—� c � � I � : <br /> � — �_ . � � � � (� <br /> N NSPECTION Date , . <br /> Appr ed as Construde�-� Signat re of Applicant � Dal <br /> everett PUBL�C RKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7E0 WI7HIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 FROJECT OVER 90 DAYS DURATION. � <br />