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Date��t �uElic Works Permit s ��/!�/ <br /> emc neou ��/� J 7� <br /> Application For <br /> PUBLIC WORKS P�RMIT PJOTofalFeeFee $ ��. � �� <br /> Lese AOo�Fea PeiO S � �^ <br /> Ba�ence Dua S �`�' � � _ <br /> Print or Type Only G'�f/7/ <br /> G /�.��r ��u lie �1�Jall� h1 e l�ia ��er�e7t sFaa3 �35�7-39/v <br /> Owner Mailing Address City Zip Phone <br /> 1�-P�MA • �L�i �7' ��� 3�/� �urKe7�' � de, ���eeF� q�a1Ul 0.`�5'� ' �//�/ <br /> Applicant <br /> Mailing Addr=ss City 2ip Phone <br /> - Describe Proposed Work <br /> cc�.JST�ev�rt �Are,4,�'e <br /> ---' � <br /> -' � <br /> — ,,7ya G Me/v�� ----- �.,. <br /> Projecl Address(it known) <br /> �� <br /> Atiach four(4)copies ol plans lor proposed work• Draw to scale and note tne followirg as applir,able: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions oi all existing and • Indicate North <br /> proposed structures on lhe lot • Shew dny proposed prading changes <br /> • Er.isting and proposed utilities • Slow measurements M <br /> W <br /> DO NOT WRITE BELOW TH!S LINF O <br /> PEFMIT 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 wi�h lhis permit and current Ci�y cl Everett Design and Construction <br /> Standards and Specilications. � <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> ` � c�u`� : i�f 1 4 t'JN I / O <br /> � �f� ✓r- wa� -to �� �C C�me��. �v M�Iv�h ` v <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMEN-�O!=i:ONDITI0N5 <br /> The undersigned owner/applicant hereby agrecs to ho�d and save harm- <br /> less the City ol Everett Irom any and all claims 1or dama�es, cosls, <br /> // expenses, or cause3 0l action that may arise because of installation <br /> / �+�' /, , — C' � -�� and maintenance ot �he imProvemen� or other righhof-waY use hereto <br /> "6/ applied for and Wrther agrees to remove same upon notice Irom the <br /> ApGr r C••ir ion � te Ci�y and to replac publi�property damaged ihereby. <br /> � � L <br /> FINAL IN ECTIO �a � Dale <br /> Approved as Constructed Signature ol APplicant <br /> everett PUBLIC WORKS DEPARTMENT <br /> BO�D VSTOF �ATE PERMIT iSEISSUED ANDB HEREAFTER ISHTO <br /> � 3200 Gadar S;reet BE DIUGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANGELLED BY THc CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> L_ <br />