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_ _, <br /> Date� /y/��f Pu01ic Worb Permi�r <br /> Application For eiaa.oeo�.� <br /> PUBLIC WORKS PERMIT PubTotelfaeFee S <br /> Lass Ap�L Fee PBid S <br /> Belence Due S <br /> Print or Type Only <br /> � /� p > / / <br /> iti / �C �c � ,� 'l. ��( �J�c�l"(NC�I,,,�JI�i' �IC�I�;�� ��G(�/ LJ �-���I/c� <br /> ��� Owner Mailing Address� City Zip Pho <br /> �, of� c�ly i'725� <br /> p—� PP�j� Mail+ng.�ddress Cily Zip Phone <br /> J,J 'f' � Z <br /> l�/� �' ��—� f I\'S' �/` �� 6') �Q / �,�1�1 !'I 4 v d � <br /> Describe Proposed Work � � <br /> ,L,�.�-�t''�lS �' � � C� Z j`�d✓ S•P �' 7C.,SL �, <br /> 7^ W " <br /> � T <br /> El �^ jl /�. �1 /l�' � �QIC'/�LC G Ly.I, � �� � N S <br /> Pro�ect Address(if known) m <br /> v <br /> � co <br /> Attach four(4)cooies of plans for proposed work• Draw to scale and note the following as applicahle: m o <br /> � � • Centerline of streot � � <br /> • Praperty _mes '� � <br /> • Outline and dimensions ol all existing and • Indicate North � -'– <br /> • Show an ro osed 9radin chan es = � <br /> proposed structures on the lot Y P P 9 9 <br /> • Existing and pmposed utilities • Show measurements /� m � <br /> W .� _ <br /> DO NOT WRITE BELOW THIS IINE O �_ <br /> PERMIT CONDITIONS 1 t�i� <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. R-'+ "� <br /> -n <br /> 2. All work shall be perlormed in accordance wilh ihis permit and current City of Everett Design and Construction ♦ o D <br /> Standards and Specifications. • <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424•5555. � "�m <br /> x <br /> m � <br /> N <br /> O o r <br /> n m <br /> j C N <br /> // N <br /> , L r^ <br /> /' z c� <br /> / � � � �l?`�✓�. /Y.�;7 � � � <br /> U <br /> ���� %n J " �/� �' - � _ <br /> � � /��-�� . ���� U S,�.Y�l Z <br /> � ' 7/ ,���f-�� , , O � <br /> ,/� �>'YN� ^ , � �� ."' _ "� C�iG�� r a c^ <br /> w. • b..' <br /> (i[' r � � <br /> � ► .- J .Y�YI�'..ci L • •il`� L `L� L� O <br /> ��-���� ��� ,� �j�.'�-� / � <br /> n <br /> c� ACKNOWLEDGEMENT OF CONDITIONS m <br /> •�`� The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City oF Everett from any and all claims tor damages, costs, <br /> expenses, or causes ol aclion that may arise because ol installation <br /> . <br /> and mainlenance of ihe improvement or other right-ol-way use hereto <br /> applied for and further agrees to remove same upon notice rom t e <br /> Approved br Construction �a�e City and to replace public property damac�ed thereby. <br /> FINAL INSPECTION �a�e Date <br /> Approv:d as Constructed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPAFTMENT 7g0 DAYS OF DP.TE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVEF SO DAYS DURATION. <br />