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i <br /> � �,� �r� I Publi<<'�'orksPer �y �� � `� J <br /> D3te_I f)}7-S BI09.OePt.r���2� <br /> Applicatlon For __—. — <br /> PUBLIC WORK� PERMIT PuOTotalFaoFee 5��,, u�,_ __ <br /> leas Avol F¢e oaia S—�--�"""'-- <br /> J��. L� �� <br /> Bale�ceDua s.._- <br /> Print or Tvpe Only ! <br /> n �� td� y��t9 ��f��`K ��.J �lu,�,���wd ��R S-ra3� �ys-o�d.z <br /> � l r�� 2io �,none <br /> Owner Mailing Address <br /> City Phone <br /> Applicant Mailing Address Z�p <br /> n � �PPJ'1�P,J�P <br /> Cescribe Proposed Work (L�P� ) Sfa� �e 'ri Ahir �4 — <br /> W <br /> _ � <br /> Proiect Address(if known) <br /> �zl�� . � � `� l��e orcz Wa_ <br /> —'-- _ <br /> Attach four(4) coUies of plans lor proposed work- Draw to:cale a�ti�r�4i.:`'��enllerline ol streei'eble: � <br /> • Property Lines � Indicat: Norlh <br /> • Outline and dimensions of all existing and � ShoH•any proposed grading changes <br /> proposed structures on the lot �� g�iow measuremonts � <br /> • Ezisting and proposed utilitics <br /> DO NOT WRITE BCLOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 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 Cnnstruction <br /> Standards and Specilications. � <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUME,ER 1•800•424•5555. <br /> ;� n)o i°��e'�I�T•s issu� ,�.e c�v.rr�uc��v� O <br /> (.C/I�T/L `�P4/✓�.^_��'f/ �//��� �' J�jEJTT1JG—r✓%�� /���'� � <br /> � <br /> O <br /> ll�w <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The under�lgned ownedapplicant hereby agrees�o hold and save harm� <br /> less th-a City of Everett trom any and all claims tor damages, cosls, <br /> �—� � expenses, or causes of action that may arise because o� installation <br /> and main�enance of lhe improvemenl or other right•ot-way use here�o <br /> �0��'�� appliad tor and further agrees to !emove same upon notice irom the <br /> Approved for Consiruction Date City and to replace p�blic propert�damaged lhereby. <br /> l i � � �J�- <br /> ��� • 1Al �c�"��A�1_ <br /> 1 � <br /> �_/-��T �" r-�-�_ � . ! �l�� <br /> � Date �— <br /> FINAL INSPECTION ig at�re ol Applicanl Da e <br /> Approved as Constr�cted <br /> WORK AUTHURIZED BY THIS PERMIT MUST BE START�D WITHI <br /> everett PUBLIC WORKS DEPA7iMENT 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAPi�ER IS TO <br /> � 3200 Ceda� Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPCN ANY STOPPAGE OF WORK ON THIS <br /> Phon<_-: 259��815 PROJECT OVER 90 DAYS DURATION. <br /> � <br />