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- -- _._ ._._. . �N .t�Gs' <br /> Date �— <br /> ��� PUEIIc Wo�ks Pa�mil• ��� <br /> � � ' � BIAp.Depl.• <br /> Application For <br /> PUBLIC WORKS PERMIT PubiicWorksFee <br /> Totel Fae s <br /> Lesa Appl Fee PeiG S <br /> Print or Type Only B°�.°`°o°° s � C�A�GE <br /> DA�'�� A �-TEA�/ /rJ•TNl/�o.6 5�B-E,MA.e, l�iE�D.e EdE.FE�1 a.s"9-/.S�/ <br /> Uwner ' Mai{ing Address City 2ip Phone <br /> ..Sfs�I+��� <br /> ,4pplicant Mailing Address Cily Zip Phone <br /> Doscdbe Proposetl Work IySTALL /9 /1! � � ZO � �.F'/L/Eu/%f� D/!� <br /> ��- <br /> E. in.9.P�.uE v�F�✓ �,P <br /> W <br /> Pro�ect Address�il known) 's'�� — E <� ,Q/NE �.l � <br /> Attech four(M1)copies of plans lor proposed work• Draw to scale and note the�o��owing as applicable: � <br /> • Pruperty Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate NoAh <br /> proposed structures on the lot � Show any proposed grading changes <br /> • Existing and proposed ulilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calis for inspection shall be made 24 hrs. in advance•phone 259•881$. � <br /> 2. All work shali be performed in accordance wilh this permit and current City of Everett Design and Construction <br /> Standarils and Specificationa <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER '-800-424•5555. � <br /> AL! C'o.�o�rio•✓s .c�orEo �' a� PE.e�s.T Bz/z/o O <br /> �� " P c' "� �/ I"� <br /> � � � ��� � <br /> O �,,, �� , � �l �e� ``' O <br /> l � Ni✓ie p� J�^E �C•S � <br /> �� �� N� re� ��.�/�J� � � �� <br /> � �,n e� W � ��u W <br /> ACKNOWLEDGEMENT OF C NDI kS <br /> The undersigned owner/epplicant hereby a es to hoid and save harm- <br /> less the City of Everett from any and ail claims for demages, costs. <br /> �i����L�C �//� (i �j8�o ezPenses. or causes of action that may arise because of insta�lation <br /> and maintenance ot lhe improvement or other�ig��t•of•way use hereto <br /> applied for and lurther agraes to remove same upon nolice irom the <br /> � Approved lor C nstruction Date City and to replace public property damaged thereby. <br /> FINAI INSPECTION Dale `/ �aH ���lbL �i�^ � � `3�8�C <br /> A�Proved as Constructed Sign re o(Appli ant Date <br /> everett PUBLIC WORKS DEPAR?MENT WORK AUTHORIZED BY THIS PERMIT MUST 0E STARTED WITHIN <br /> � 3200 Cedar Street 1A0 UAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelf.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />