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i <br /> , <br /> � Pu�Lt WorFs Permil• <br /> Date 7 k7� <br /> Application For eia9.oeo�-•�r— <br /> PUBLIC WORKS PERMIT PUOTo�FeoFee S <br /> Less ADO��Fee Peid S <br /> Belance Due S <br /> Print or Type Only <br /> a�6 Ge�. Ad�,;N. .Blc��, j �y <br /> -v�� .._ , � o � Gck� 9 <br /> 4`�n`�u r� �A�rcti d �.,fl Ot�SFT /� �1 / ) A dS� <br /> Owner Mailing Address City Tp Phone <br /> 7�-L�„',I�ars szil S L.n.�nlp . R�l `a'MqIPH �aGo 3zi-� ��3 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �g,kl¢0(�k_�k!'�"�' �1� �a /20Y1l�� �1(Q f(q 1Y�NIL��L� <br /> W <br /> Prolect Address�il known) a 7� (9n�u c A � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicab�e: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilitles • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. Atl calls for inspectfon shall be mede 24 hra in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in eccordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> P�/��i G Gc�o�,Es- f C�<��; .c hr ,P��7a.i�o 5�-�.3-�7 O <br /> ��� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownor/applicant hereby agrees to hold and save harm• <br /> le�s the City of Everett from any and all claims for demages, costS <br /> expenses, or causes of action that may arise because of Installation <br /> and mainlenance of ihe improvement or other right�of�way use hereto <br /> applied for and fuAher agrees lo remove samo upon notice from the <br /> Approved lor Construclion Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPAR7MENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everetl.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />