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Date �� (/ ✓ PubLc WoiMs Permil� ���-�`�3 <br /> Application For eia9.oeoi.• <br /> PUBLIC WORKS PERMIT PubhcWorkaFee <br /> Totnl Fca S <br /> Less AOV�.Feo Peid S <br /> Balance Due S <br /> Print or Type Only <br /> �a ; �� /�a �n u ►sLs.� N'la�, w. �/ ;ew D� ���e�e-tf' 98zo� <br /> Owner Mailing Address City Zip Phone <br /> ���1 J'a Lt, rN14J� /5�1 � �iGIC�/SCK.. SAa��Q. 7� �/'7 ZcY'� �� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �v �_� 5����/ /�/�CTl�j/� -«!✓ � _ <br /> Project Address(if known) � ,/ � <br /> � <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines � Centerline of street � <br /> • Outline and dimensions of all existing and � Indicate Norfh <br /> proposed structures on Ihe bt • Show any proposed grading changes <br /> • Exis�ing and proposed uti�ities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for inspection shell be made 24 hrs.in advance•phone 259•8870. � <br /> 2.All work shell be perlormed in accordance with this permit and current City of Everelt Design and Construction <br /> Stendards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � �� /G�!v� �i/i �-�J �� ��� O ,. <br /> � <br /> 11/ib/88 11�22AM OOORN3431 � <br /> / <br /> N000143� <br /> Pbl PC f36.� a <br /> PWINSP f230.00 <br /> DFT.20 f6.� <br /> CHECY. �L7^c.BO <br /> ACKNOINLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees�o hold and save harm- <br /> � less the City ol Everett irom any and all claims for tlamages, costs, <br /> expenses, or causes of action that may arise because ol installation <br /> � � and maintenance of Ihe improvement or other right-ol�way use hereto <br /> � applied for and lurther agrees lo remove same upon notice irom ihe <br /> Appr¢ d lor Co truf,li n , Date Ciry and to replace public property dama9ed thereby. <br /> FI INSPECTION �� � � `` �, <br /> Approved as Constructed ignat e of Applicant Date <br /> everett PUBLIC WORKSDEPARTMENT 6VORK AUTI10RI2ED BY THIS PER 1T MUST BE STARTED WITHiN <br /> � 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA9B201 BE DILIGENTLY PURSUED TO COMPLEIION.ThfIS PERMIT MAY BE <br /> Phone:259�0810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUHATION. <br />