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, <br /> Date.�-1�-�� a�oi�wa,ws ve,�,�i• CJ8/ <br /> Biap oeo�-• � <br /> Application For <br /> PUBLIC WORKS PERMIT PunTa�FeaFee s -- <br /> �ess R�pl.Fee Pald s <br /> Balance0ue S. <br /> Print or Type Only <br /> ��,� � ��,�-�,I TI-,.�F�r� �r�i �� �n� ,�� s�����-� q�o� <br /> Owner Mai�Address ity Zip Phone <br /> �rc�U r� ��S '1► 3 � ��� 11�1'11� (� ' i,l �'1°�'Pf�" ���l�� ' <br /> Appticant Mailing Address City Z p Phone <br /> 1`�C�d I a� L Y�JT���rf A <br /> Describe Proposed Work � � � " " � ��� <br /> W <br /> Prolecl Address(il known� . �J�2z �AKE`� �'C. � <br /> Attach four(4) copies of plans for proposed work- Draw to sca�e and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> pioposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> DU NOT WRITE BELOW THIS LINE W � <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall 6e pertormed in eccordance with this permit and current City of Everett Design and Conslruction <br /> Stendards and Specificalions. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> '_ /��'' o/'/"�a.`o�/o ,.�s.s c��c� .S'-3- �3g � <br /> �i <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applican�hereby agrees to hold and save harm• <br /> less ihe City ot Everetl trom any and all claims for damages, costs, <br /> erpenses, or causes ot action ihat may arise because el installa�ion <br /> � and maintenance of the improvement or olher righ�-obway use hereto <br /> v applied lor and lurther agrees to remove same upon notice trom the <br /> Ap ved 1;r Co t i � . �a�e Cily and to replac pubf property aged thereby. <br /> �. � - ^�.Z .L ��" <br /> FINAL INSP ION �a�e Date <br /> Approved as Construded Signa ure of Ap licant <br /> WORK AUTfiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DA1'S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceda�Sireet BE DILIGEN f�Y PURSUED TO GOMPLETION. THIS PERMI7 'v1AY 8E <br /> Everett,WA 90201 i;ANCELLED 81"THE GTY UPON ANY STOPPAGE OF WORK Orl THIS <br /> Phonc:259�8810 PROJECT OV[R 90 DAYS DURATION. <br />