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�I\� )r� /L)z � �I' � i 2S9 <br /> Date.��W : � �I , Pu�Lc Works Pormlt s � / <br /> �, �d 6/_ <br /> Application For _ _ e�aq.oeo� • <br /> Pl16LIC WORKS PERMIT � . ` �"` '°'°°"'°'kSFee , <br /> tolal Fea s� ' O � <br /> . _.__................._ .. .... . LessA�otFeePaid S <br /> (;� I `( Qi r�1�i:�".r � Baianceooe S� �� <br /> Print or Type Only <br /> ��✓�s�� <br /> �l�/� A�d '�ieA�lF ��.1� � ����P4@I�IrT� �u�i �JCI2E� 3V/J - r�6,r" <br /> Owner Mailing Address Ciry Lp Phone <br /> �S�n,e, <br /> Applicant Mailing Address City Zip Phone <br /> Describe Propesed Work _('�-�—�L��'� C '4�R�S� <br /> W <br /> Project Address(il known) � 0��� �1�'�I�1�^� �J e�- H <br />� <br /> Atlach Icur(4)copies ot plans for proposed work- Oraw to scale and nole the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Ou�line and Jimensions ol all exisling and • Indicale Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls(or 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 Cily ot Everett Design and Construclion z <br /> Standards and Specifications. � <br /> � <br /> 3. Call Location Underground Service 46 hrs. before you dig.TOLL FREE NUMBER 1-800-424•5555. � � <br /> Cr^. <br /> O <br /> � r-' '- <br /> � '_ <br /> � � . <br /> � " <br /> O r <br /> O ~ � <br /> C+1 _ <br /> O � <br /> � a F <br /> y ; <br /> � <br /> � :. <br /> AG<NON'LEDGEMENT OF CONDITIONS � ' <br /> H . <br /> � . <br /> The undersigned owner/applicant hereby agrees to hold and save harm• J. <br /> less the City of Everett from any and all claims lor damages, costs, � <br /> expenses, or causes of action that may arise beCause ol installation - <br /> /D-�9- �3 and maintenance ol the improvement or olher righPof-way use here�o � ' <br /> applied lor and further agrees to remove same upon notice trom ihe �``.- . <br /> Ap r Co truclion Date City and lo replace public property damaged thereby. � � <br /> � ( - � �- r ��.e.. P //��-�Y3 ' <br /> FINAL IN CTION Date P �L�LT,{,, t; <br /> Approved as ConstructeC, Signature of App�enf Date � I <br /> WORK 4UTHORIZED BY THIS PERIv11T MUST 8E STARTED WITHIN <br /> everett PUBLIC WO��:<S DEPARTME T 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar S;r�et BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everetl.WA 98Y�' CANCELLE�' 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8875 PROJECT C VER 90 DAYS DURATION. <br />