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Date r7 c�S Pub4c Worxe Permil � �-� �j� <br /> Applica�ion For Bloy.Deo� • .-- <br /> PUBLlC WORKS PERMIT P°°��°W°�k°�°° _ <br /> iotH Fea S <br /> LLss Appt Fae Pa10 s <br /> BelanceDue S �/� �y��"�� <br /> Print or Type Only <br /> G'��6.�D�t��c�� �S�s� ��c%F.'C --,���',�cTi ��ab / �S �/ aaa <br /> Owner Mailing Address City Zip Phone p <br /> -� <br /> /�'�i/JA�ir` ,��. L/�r2S /S�/�'i'i3� 5/� A!/l' !sJ L-'�o�tJ/l.S �G�( / �3'_ G� 3i r,�',' <br /> Applican� Mailing Aadress City Zip Phone —��— <br /> .y a. <br /> /�:1 . —1 �1 <br /> Describ�Proposed Work __M_��� . �-+ m <br /> <n x <br /> i o <br /> � ' � f " .� m o <br /> W �� <br /> Project Address Iif known) � � . � m ~ <br /> Attach four(4)copies of plans for proposed work- Draw to s�ale and nole the following as applicable: � � � <br /> • Property Lines • Centerline ot sireAt � r x <br /> � Outline and dimensions of all existing and • Indicate North �N <br /> proposed structures on ihe lot • Show any proposed grading changes < <br /> T <br /> � Existing and proposed utilitius � Show measuremenls � �D <br /> DO NOT WRITE BELOW THIS LINE O = m <br /> PERMIT CONDITIONS m~ <br /> N <br /> t. All calls for inspection e.hall be made 2a hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perfOrmed in accordance with this permit and current City of Everett Design and Conslruc�ion � 3 N <br /> St;.ndards and Specilications. I'n <br /> 3. Call Location Undergiound Service 48 hrs. before you dig.TOLL FPEE NUMBER �-8OO•4Z4•SSSS. � „_„�r <br /> • m <br /> a <br /> � p <br /> -� <br /> x <br /> a <br /> z <br /> � � <br /> � N <br /> z <br /> c <br /> o -� <br /> ... <br /> �: <br /> a � <br /> ACKNOWLEDGEMENT OP CONDITIOIJS <br /> The undersigned owner/applicant hereby agrees to hold and save horm- <br /> — �ess ihe City of Everett Irom any and all claims for damages, costs. <br /> /� Iy� , expenses. or causes ot aclion Ihat may arise because of installation <br /> `� (-y�`i !—' ,(/,J�y�� ,��'�, and maintenanr,e of �he improvement or other right-of-way use hereto <br /> V „ '—� � ��� "��'�C""�-�' =s��� -S apf.�ied br and luriher agreeo to removc same upon notice from ihe <br /> ApProved for Constrdction � _ a�e City and to replace public property damaged thereby. <br /> ���� . � -� -J6 �; � ; " � ' � � � <br /> �NAL IMSFECTION Date � � � <br /> ApprweA as Constructed Signature of ApP��caM � Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST STARTED WITHIN <br /> evrrett PUALIGVlORKS pFPARTMENT 1g0 DAYS OF DATE P[RMIl- IS ISSUEO AND THEREAFTER IS TO <br /> � 3200 G�dar Slreet gt DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EveretL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Fhone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />