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Date_��9 '�i6 P�o�,��vo,�,Pe,m,�. ��n lU3 <br /> Application For eiep oeo�.• <br /> PUBLIC 1MORKS P�RMIT PueTo�alFeeFee s u,,� <br /> L¢s6 Appl.Fee P0�4 S�a_ <br /> Print or Type Only Ba'a"`Qo"" 5 Z0� <br /> 1a1�,ER,cA� '700� 3s3� ��qtu� si . EvE(��i 98a-c�i a �.� -1s�1 <br /> Owner Mailing Address City Zip Phone <br /> ��` Ui,.� <br /> ApplicaM Mailin9 Address City Zip Phone <br /> Describe Proposed Work __ 3LtICKTOP ( N (�j: U�t/T � F �L�(� . <br /> - W <br /> ProjectAddresc�if known) 5�1�itit C� I�' �-�O//� � <br /> Attach tour(4�copi?s of plans for proposed work- Draw Io scale and note the following as applicable: �i <br /> • Property Lines • Centerline ot street /w <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exisiing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PEIiM1T CONDITIONS <br /> �. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in acwrdance with lhis permd and curren�City ol Ev�rett Design and Construction <br /> S�andards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 9 � i^L/�lLi.�E f YI I-/'ON%_U( COCl d/I+r ddd r �—Q'� 1��/47/ � O <br /> � � / <br /> GC.��r�Y1 �is/.1-� <br /> ♦ L <br /> ��- <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less �he City of Everett irom any and all claims lor damages, cusis, <br /> � � __ ___ expenses, or cause� of action that may arise because ot installation <br /> - / � and maintenance ef �he improvemen� or other righbol�way use herelo <br /> applied lor and h;rther agrees to remuve same upon notice Irom ihe <br /> Approved lor Consirudion Date City and�o replace public property damaged thereby. <br /> _�—, j. <br /> � �2�% �e�C � �/ �'�� 1.'SL� �� —SLlR_ <br /> FINAL IN�PECTION Date 2^-�,- �-r ��" <br /> Approved as Consiructed SignaWre of Appiicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST 8E SiARTED WIThiIN <br /> � 3200CedarSireet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 DE DILIGENTLY PUfiSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259-8815 CANCELLEO BY THE CITY UPON ANY STOPPAGE OF VYORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />