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Date� � � �����,�wo,�s v�,m�. _ <br /> Application For � aiag oeai . ���9 <br /> PUBLIC WORKS PERMIT �ublicWorksFeo <br /> Taial Fee s <br /> LeSs ApP�Fee Paid S <br /> Print or Type Only Balante0uo S <br /> �ti., 7n,-da.r 1.519 (')�l� Pc 4 zDl 38� � / �/p� <br /> Owner Mai4mg Address ��� City � Zip �'�p�e <br /> ' /�sa/ � ✓ � ,ir, l,v,�l <br /> ! p�n�o,�i,�f ��u ���---�---q.�tt[�s4� gA�03 7 7SL�/SS�_ <br /> Applicant Mailing Addre� � City Zip Phone <br /> Describe Proposed Work .r-i pr.�_Ta�h[�I1�/i1�11'�!',-(� <br /> .1 ,J � -• <br /> W <br /> Project Address(if known) IS�9 �.(��p.� �•�.� � <br /> . Atlach four(4) copies of plans br proposed work- Draw to scale and note ihe lollowing as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outline and dimensions of all existinc�and • Indicate Norih <br /> proposed struC�ures on the bt • Show any proposed grading changes <br /> • Existing and proposed utilities • Show 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 O. � <br /> 2.All work shall be perlormed in accordance with this permit and current City ot Eveiett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•$00-424•5555. � <br /> ��/�4/GC� ��2r �.r2.27,u-�/I/t3�'!`��L[�4-t.r�/�' , O <br /> ���,a-�- N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> ��, The undersic7ned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City ol Everett Irom any and all claims lor damages, costs, <br /> expenses, or causes of aclion that may arise because of inslallation <br /> and main�enance ol �he improvement or other ri�7ht�of�way use hereto <br /> appCed lor and furiher agrees to remove sa�ne upon notice Irom the <br /> Approved lor Conslruction Date City and to replace public property dama�ed ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol ApplicaM Cale <br /> everett PUBLIC WORKS DEPARTMENT WOFiK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJFCT OVER 90 DAYS DUfiATION. <br />