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._ _ .. ��:��� <br /> Uate�I�g�7 r�m��woa.vs,�I� <br /> �""'�1 /�� <br /> � • ApplicE Fof . . Biap.Deoi.• <br /> PUBLIC WORKS PERMIT P�DToIeIFeeF� : <br /> Lesa�oo�Fee Paia � <br /> B�lence Due � <br /> Print or Type Only <br /> 7.��erb A-�, �3� � rYJ��;lfea 48a�s �ss— yi�, _ <br /> Owner MaiNng Ad ress City Zip Phone <br /> SaMP <br /> Applicant Maiiing Address Cdy Z�p Phone <br /> Describe Proposed Work _f111(2d� i m�MAn�— � �(�1/ — �p'f� Sfi�h(�' !J 7��yY �1 <br /> /� W <br /> Project Address(il known) ��n ��a�1}������J � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Linea • Centerline ot street � <br /> • Outline and dimensions of all ezisting nnd � Indicate North <br /> proposed structures on the tot • Show any proposed grad�ng changes <br /> • E�iating and proposed utilities • Show mtasurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inepaction shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Stende�Ae and 3pecifications. <br /> - 3. Call Locetion UnOerground Service 48 hrs.befo�e you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /-Z/-g7 O <br /> f�,.4^33L�C C�1orP�� 1��/�"i.voT .PEqU�.e�`.o �li�ir� <br /> `�J <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City of Everett Irom any and all claims for damages, cosis, <br /> expenses, or causes o1 action that may arise beczuse of installation <br /> and maintenance of ihe improvement or other right�obway use hereto <br /> applied lor and furiher agrees to remove same upon no�ice lrum ihe <br /> Approved for ConstruCtion Date City an�to replace public property damaged ihereby. <br /> FINAL INSPECTION �a�e ;late <br /> Approved as Constructed Signature ol Applicant <br /> everett PUBLIC WORKS DEPARTMENT WORK AU7"HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DUFATION. <br /> � <br />