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9g�� / '� i L���/. <br /> �� Pu01ic Works Permi�• ��_�_�,�✓ <br /> Application For eieo.Den�.+—. <br /> PUBLIC WORKS PERMIT Pu01i<WorkaFeo <br /> Toiel Fee S <br /> , Lesa ApP�Fee PeiO $ l',p <br /> Baiance Due S �� �-/�//��� <br /> Print or Type Only <br /> Z�LT�r`/�//� �f"�1T�1 . �//I� �JE�� �� ���� .c�.�g 333� <br /> Owner Mailing Address City 2ip Phone <br /> �--��n� <br /> —A�pplicant Mailing Address City Zip PY:ne <br /> Describe Proposed Work �L T/ � <br /> - � Co�-G.,d r.c�uc,rs <br /> Prolect Address(if kno�vn) � � � <br /> _ � <br /> Attach four(4) copies of plans lor proposed work• Draw to scale and note the toilowing as applir.able: � <br /> • Property Lines • Centerline of straet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot ! Show any proposed grad��ig changes <br /> � Existing and proposed utilities • Sh�w measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current Ciry ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Locaticn Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> �/ �i�v�2� �,�� �t'���,�r� L'�c�-,� o <br /> 5 ��idi�1� L�I�r��s �`,�//�e.��Q��r ����:.� �. <br /> �. �,er�rr ������ /�%�e �o a.� �� o��� N <br /> � �� �I�.��'���� ��r� �Q�ed %",�,�;�� � 0 <br /> � �� 5� a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneri applicant hereby agrees to hold and save harrc <br /> � less the City ol Everetl Irom any and all claims for damages, cosh, <br /> zpenses, or causes of action that may arise hecause ol installation <br /> G � j�� and maintenance of the improvement or other right�of•way use hereto <br /> � applied for and lurther agrees to remove same upon nolice from the <br /> Approved r Construction ' ' �-y- Dat City and to replaee public property amaged ereby. <br /> -- ���� s=i��� ` - , �_ -� <br /> AL INSPECTION Date v� <br /> Approv�d as Constructed ,_$ig ature Applicant Dale <br /> everett PUBLIC WORKS DEPARTMENT H'ORK AUTHORIZED BY THIS PERMIT A1UST BE STARTED WITHIf< <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED ANO THEFEAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS f'ERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />