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�' �' .i'� '' <br /> ia ��� -.-E- � ,� , 8�. _ y <br /> Da�e PUUIir.N'nrAe Pa�rmci-i�• ����� <br /> Application For eiaa.oeoi.•�_•'✓ �" _ <br /> PUBLIC WORKS PERMIT PuplicWOrksFee • / <br /> Tolal Fa� S_ <br /> , �tl5]ApP�FBB PA�U �1� <br /> Print or Type Only � (/ ee�o��a o�, s -��� <br /> �-��� ��-v , ly� % �Y�--U--ti� s��,,����� �sG��93�� <br /> Uwner Mailiny Address Ciry Zi Phono <br /> � � ��-�-�.�-�/ `�3�7��3 9�P Sf��w , 95-�-�I G -��5� %`3�Z <br /> pp;icnnt Mailing Address Cit <br /> Y ZiP Phone <br /> �. / <br /> Describe Proposed Work �/YS-��C� �_.��Zh'Y��� ���6�yu� <br /> � <br /> Project Address(if known) _ ____.J✓'�GQ — E I7Jh' iifJE G> G✓ � <br /> Attach four(4)copies of plans tor proposed work• Draw to scale and note Ihe Ioilowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed gradinq changes <br /> • Existing antl proposed utilities � Show measuremenL; � <br /> DO NOT WRITE BELOW THIS L�NE <br /> PERMIT CONDITIONS � O <br /> 1. AII calls for inspection shall be made 24 hrs. in advance-phone 259-881 5. � <br /> 2. All work shall be performi3d in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underpround Service 48 hrs. belore you dig.TOLL FREE NUMHER 1•800•424•5555. � <br /> ' <br /> 7; F�CG'ESS r,c� TNiS LOT /�7G�ST !�G OFf ALLE,/ Q <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less Ihe City of Everett Irom any and all claims lor damages, costs, <br /> j� � expenses, or causes of action that may arise because oi installation <br /> � `j���� �� �y g� and mainlenance of lhe improvement or other righlrof�way use hereto <br /> Approved for Constr ion plied for and further agrees to remove same upon notice Irom the <br /> . ,. Dat Ci and to replace puhlic roperty damage�dJ ihereby. <br /> � � 2 t—E� " _""' C-I J �� <br /> FINAL INSPECTICN Date C-Cl�1..Q /�j.�' <br /> Approved as Constructed Signature ol Applicant � D te <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2E0 BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER.IS TO <br /> Everetl, Wq g8201 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 OVEH 90 D4YS DURATION. <br />