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� <br /> . pB�B��� Pu�lic Works Psrm11 s _S� <br /> • Applicetion For Bldp.Uepl.• _ <br /> PUBLIC WORKS PERMIT �/' / P°°T;,:FeeFee s�_ <br /> (j�7"� �� LeuAOG�FeePaiCs� <br /> I Print or Type Only e�ie�oao�e S -��1.5 � <br /> l01�00 7/�oZ,S" <br /> � �o.-� �� <br /> u0�1v �Et �?S6�1r 6l0 24t>�9F sl� $�LK4� qbDl � 4i�� w� <br /> - dwner iling Address City Zip Phone <br /> � �I �1li5 S.wpslpN�dl�r� -�on�o�- 1,°b��i 'I5�-�3�'-✓ _ <br /> Appllcent Melling Address 1.�ty i�� Phone ..�.� <br /> �'161dG LMmM�vFsMEt� � �LG6V � <br /> Deacribe Propoaed Work ,�_ r m <br /> .+ .. <br /> . � � <br /> r W Nm <br /> g.� � y� o <br /> Project Addreas(if known) 7" 7� � m� <br /> -i c <br /> Attach four(4)coplea oi plans for proposed work• Draw to scale end note the followi�g as applicable: � � � <br /> • Property lines • Centerline ol street � _ � <br /> • Outline and dimensions of ell existing end • Indicate North m <br /> proposed structures on the lot • Show any proposed grading changes � z <br /> • Ezisting end proposed utllilies • Show measurements � a � <br /> r x <br /> DO NOT WRITE BELOW THIS LINE K H <br /> PERMIT CONDITIONS O �yp <br /> 1. All cells for Inspection shell be made 24 hrs in advance•phone 258•881 5. s <br /> 2. All work ahell be performed i�accordnnce with this permit and current City ol Everett Design and Construction � = m <br /> Standerds and Specllicationa r^ "" <br /> 3. Call Lxation Underground Service 48 hra before you dig.TOLL FREE NUMBER 1-800-424•5555. � � m <br /> �� �_t� �I�I'lA�G�L �/�N7.s O �m <br /> � <br /> a <br /> � A <br /> —�1 <br /> 2 <br /> � a <br /> z <br /> O <br /> N <br /> a = <br /> 0 <br /> � <br /> .. <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF COND�TIONS <br /> The undersigned owner/epplicant hereby agrees to hold and seoe harm- <br /> less the City ol Everett Irom any and ell c�aims for damages, costs, <br /> expenses, or causes ol action thet may arise because of instellation <br /> _-_8������ / /,� �^, n� end maintenence of the improvement or other right•of•waY use hereto <br /> � �� applied for and further agrees to remove same upon notice from the <br /> Approv o n Date City and to replace public property damaged thereby. <br /> ��� �/�� /� l <br /> F CTION Date ----���e16 v /1T` <br /> �proved as Constructed Signature ol Applicant � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Fverett,WA 98201 BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � PROJECT OVER 90 DAYS DURATION. <br /> L a <br />