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,ate�Y�/ Pu�Lc Worke Parmit a � 30 <br /> Appiication For e�ap on�.+ <br /> PUBLIC WORKS PERMIT PubTotalFeaFae S � <br /> Lasf aoul Fae Peie S� <br /> Print or Type Only Ba�a�=,o�a s �J � <br /> �n�o/� !� ��iJ��� /D/.�/ / '�,17r- .S� .Fi �3.5:S� .�i"/3 d <br /> Owner Mailing Address City Zip Phone <br /> �� 1.����[3 /22 u C���.�,a.�, .�• 7.,.. ,...,zk 9`� 2 �y � s�, 3 s �y <br /> �Applicant Mailina Address Cily Zip Phone <br /> Describe Proposed Work _ U��-i-�-ou� ��^-,-+n,�t � 7JJ �,��a-t/j� <br /> ProjectAddress�.. Known) /_� ,�_,�.�ll�/� � � <br /> � <br /> Attach four(4)copies ol plans (or proposed work• Draw to scale and note Ihe lollow,ng as applicable: � <br /> • Property Lines • Cenlcrline ol street � <br /> • Outline and dimensions of all ezisting and • Indicale North � <br /> proposed slruc�ures on ihe lol • Show any proposed yrad�.�g changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO ivUT WRITE BELOW TH!S LINE � <br /> PERMIT CONDITIONS <br /> i. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be periormed in accordance with ihis permit and current City of Everett Design and Consiruction <br /> Standards and Specificadons. <br /> 3. Call Localion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � � � � �y ,a- 9 _ � � � t; o <br /> -S�. � r G/�ari j �cL +� �/�'�'UbUiYt�/ QYl� � <br /> �T � J � <br /> � � <br /> � <br /> o � <br /> a � <br /> � <br /> C <br /> K <br /> < <br /> ACKNOWL[DGEIdENT OF CONDITIONS E <br /> ihe under�igned owner/applicant hereby zgrees�o holtl and save harm� . <br /> , less Ihe Cily o� Everett Irom ;,ny ano all claims tor damages, cosis, ` <br /> ezpenses, or causes oi action thal may arise because o� installalio� ; <br /> and maintenance of the improvement or other right�ol�way use hereto <br /> applied lor and luriher agrees to �emove same upon notice Irom the � <br /> Approved , Co uction � Dale City and to replace public property damaged thereby. �� <br /> i <br /> l� —�� 'S f7��-fj- � .f.lr7- O '��J� � <br /> FINAL INSPECTION Date � �� <br /> Approved as Constructed Signat ol Applicanl Date E <br /> everett PUBLIC WORKS DEPARTMENT WOR AUTHORIZED BY THIS PERMIT NMUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 6E DILIGENTLY PURSUED TO COA1PLETION. THIS PEFMIT MAY BE <br /> Phone: 259�8875 CANCELL[D 6Y THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECI OV[R�0 DAYS DURATION. <br /> l <br />