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� v . -19•.: <br /> �„�,;. ,-, : , 8� - 5�7s <br /> Da�B I� Pvblic Wo�ks Parm�l i _/7_� <br /> � <br /> Applicafion For Bia9-DepL• <br /> PUBLIC WORKS PERMIT P°°°°W°��,F°° <br /> Tolel Fee S <br /> c� Lese PD�t Fae Peia S <br /> Print or Type Only r �\j �� Ba�o�=a o�e s ��� <br /> l� <br /> �"� �n �� s �3r �a N�I v o Id - �s3o�-�� ���F�.9s�y�� -_ �-����3��_ <br /> �wner MailingAddress City �ip Pho��a <br /> t,c��0��i�� ���- i3g �� 5 �� y�2-90 5� �-- 93�� <br /> Applicant Mailing Address City Zip Phone <br /> � ,/� <br /> Describe Proposed Work -li`�c r ��`�-�`"�f 1�SC.c...-�.^-^�t'Q- <br /> W <br /> Proiect P.ddress�,if known) .S�D- E; h7.9.�,�i.tlE �/ECcJ d,e, � <br /> Attach lour(4) copies ol plans for proposed work- Draw to sca�e and note the lollowing as applicable: � <br /> • Pruperty Lines • Centerline of street � <br /> � Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed gradin�changes <br /> • Existing and proposed utilities � • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> � A��Ess Fo.� Ti�%r Lor �rvsr�E oFF AGLE�/. O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT JF CONDITIONS <br /> The undersiyned owner/applicanl har=by agrees to ho!d and save harm- <br /> less the City of Everett Irom any and all claims for damages. costs. <br /> j expenses, or causes ot action that may arise becau;e of installation <br /> ���_ �/ /� and maintenance of the improvement or other right-ohway use hereto <br /> ap lied for and further agrees to remove same upon nolice lrom rne <br /> Approved lor Construc� / ate City 8 A b replace publi �operty damage thereby. <br /> � 4 �j��/C� ' ., � <br /> FINALINSPECTION �_22 �Date �� C� P� l// l � <br /> Approved as Constructed Signature of Ap�t ����e r <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEN 90 D��.YS DURATION. <br />