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�,. ' - i'{•.��r:..��G��'VF'�:F,.:�+a8i��w.znn7-'��a^'.- . � .. . . -:-..::—. ...::�.�,-4Fc7--�.. '.-t,.- �:a,� ,:°. - ,--k -.-'+TS.,:-�:'`y <br /> , I <br /> pate���, ,-. � ,- 8g_ 3� > I <br /> .� ��, <br /> ; . Pu01ic Woekf Permll• ` <br /> BItlB.�eDt• 7'�`���.%I - <br /> Application For <br /> PUBLIC WORKS PERMIT PueTaalFeaFee : <br /> Lass AD��Fee Pa1d s <br /> BalencBDua s ��� <br /> Print or Type Only <br /> �1,.�tr-i "�r"� � ;�,� ��'�'",��}�Y'r �"� �,r�,� �> Y� 1�� 1< <^�Y='� C� i'�P.�- `t�:�C:� . <br /> Owner Nlailing Addr City � ip Phone <br /> �.�� ��~�. <br /> Applicent Mailing Address City Zip Phone <br /> Describe Proposed Work l ��������� <br /> Project Address(if known) ��-'.�_I�-� �}� I �� �` �'� � <br /> � <br /> Attach four(4) copies ol plans lor proposed work• Draw to scale and note the following as applicable: � <br /> . • Property Lines • Centerline of street � <br /> • Outline and dime�sions of all ezisting and • Indicate No•ih <br /> proposed structures on the lot • Show any pruposed grading chenges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> . 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•881 Q. � <br /> 2.All work shall be poAormed fn accordence with this permit and current City of Everett Design and Conslruction <br /> Slendards and Sf�ecM'cations. <br /> 3.Call Location Underg•ound Seruice 48 hrs.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> { <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for dam2ges, costs, <br /> ��' , . eapenses, or causes ol action that may arise because of installation <br /> ` �� _c ' Y, __., � �� o� and maintenance ol the improvement or other righDol•way use herec� <br /> �' � , � � �``r� � ��/UJ applied tor end further agrees to remove samo upon nolice Irom the <br /> Approved for Construction � Date City and tu replace Public property damaged tnereby. � <br /> � <br /> .. -�i . <br /> FINAL �NSPECTION Date ".� � . �,�, `.• '��.j/.�.'"� �','��' 3�,��� <br /> Approved as Constructed Signature ol Applicant � �/� � Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMiT MUST BE STARTED WITHIN � <br /> � 3200CedarSlreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO �I <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE II <br /> Phone:259�0810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. +I <br /> -- ._.--' �--- ---._. ._------- �- �- - _ .. .----- --_ -- -- --- ---_. ... _�--- ---- _.----- --_. . .- ------�- -- - - <br /> �, <br /> ill <br />