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T �' r >-:- <br /> � � <br /> DOIB '�/'? ��' r��n�wo�kscP�mn. <br /> Application For eioa o�pi.:�,�55�9.� <br /> PUBLIC WORKS PERMIT Po�hcWork:Fea <br /> Totel Feo S <br /> Less PP01.pCC Pa'�d S <br /> Print or T��pe O�ly BaianceDue $ _ <br /> /f'/. ,/ c S-�/C ` �V{o /!%=P-�Lsy�-l� G2 <br /> Owner Mailing Address Ciry Zip phone <br /> '.D�-,--� �/�/ �G�L�,u�- `��a 3 �srY'-�1Z� <br /> s = <br /> Applicant ' � ailing Adtlress City Zip phone y <br /> .-. <br /> n <br /> m <br /> Describe Proposed Work _ •• <br /> --I T� <br /> _ � �1 <br /> -- W �, z <br /> m <br /> /� / co <br /> Pwject Address(il known) / (� - �'�, _ � m � <br /> / ' <br /> Attach four(4)cnpies of plans for proposed work- raw to scale and nole She�ollowing as apD�icable: � � m <br /> • Fropeity Lines • Cenledine ol street �A = y <br /> • Outline and dimensions of all existing and i Indicale Norih �� �^ <br /> proposed strucW res on Ihe lot • Show any proposed grading changes � z <br /> • Er.isting ana proposed ulililies • Show measurements � D � <br /> rx <br /> DO NOT W�ITE BELOW THIS LIN[ O � �^ <br /> T <br /> PERMIT CONDITIONS � n <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone.259•881$. � m <br /> 2. All worle shall be pericrmed in accordance wifh this permil and c.irrent City of Everett Design and Construclion � x <br /> Standards and ipecdications. m�� <br /> 3. Call Location Ui derground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. O r <br /> �C.1LCC0 Ar-�PG.CG.✓: �O—/-8� Z c vm+ <br /> r'1/� f �' ������s� y�l-;��i.�/% � � D <br /> � _hl/� m <br /> ,_, _, � � <br /> �c�c j%C:%C��f=L? — <br /> �•r y` /�/�� � � D• <br /> Z <br /> � ~ <br /> H <br /> V <br /> � � <br /> G <br /> �{ <br /> C' <br /> f" <br /> ACKNOW�EDGEMCNT OF CONDITIONS <br /> l he undcisigned owner/applicant hereby agrees to hold and save harm� <br /> --� — less the Cdy ol Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise becausa oi instatlation <br /> and maintenance of ti�e improvement or other right�o!-way use herefo <br /> enU��ed for and luriher ayrees to remove same upon notice Irom Ihe <br /> �.pUroved br Construdion ���^- C�ty antl to ieplace public preperty dama�7ed ihereby. <br /> FINAL INSPECTION Date — <br /> Approved as Construded :Ignatuie of Applicant Date <br /> everelt PU�LIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STA.RTED WITHIN <br /> � 3200CedarStreet 7E0 DAYS OF DATE PEFMIT IS ISSUED AND THEHEAFTER IS TO <br /> [veiet�,WA 98201 BEi DILIGENTLY PURSUED TO COMPLETION. THIS P[RMIT MAY BE <br /> Phonc: 259�8b15 I CANCEL�ED �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> FROJ[CT OVER�30 DAYS DURATIGN. <br />