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� <br /> _� <br /> Date� /> �J Public Wods Permil• <br /> eme�oeo�.. <br /> Apphcalion For <br /> PUBLIC WORKS PERMIT vueTotalFeaFee s <br /> Leae Aool Fea PaiE S _ <br /> 0mence Dun S <br /> Print or Type Only <br /> � <br /> � ;��� I��� 1� � �e Y��f�������^,,,� �l,,�fl,. �<<�����-- ������� �����-���:t`� <br /> Owner Mailing Address C��Y Z�p Ui�h�L%—� J7 G /� <br /> / ✓ <br /> Cpa�i�a�� � Maihng Address Gty Zip Phone Z <br /> // p � <br /> `�, /`� �_�P' :�. ('1•'' .' �/ G� /l i' �c�,(}11 !j�?�( � <br /> Describe Proposed Work � �Y t �� J � � � <br /> / ` �- ��rr—" '�=i �' 7C, �/ m <br /> J-/-�r-,T Y'C I� � -C� T � �' �' � � �� — <br /> .. .. <br /> p� n W �' �' <br /> .. .� <br /> -//Y��/"/'����'�'' ' (J4� � /C�il" C /YJ,d.C�sf%t' ��,.1. .� " ` V' m <br /> Prolecl Address(if known) i � c o <br /> _� m o <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as appllcable: � � <br /> • Property Lines • Centerline of street ♦A o 3 <br /> • Outline and dimensions of all existing and • Indicate North V� m <br /> proposed structures onthelot • Show any proposed grading changes = � <br /> • Show measurements /y� m � <br /> • Ezisting and proposed utilities ,� Z <br /> DO NOT WRITE BELOW THIS LINE � � _ <br /> PERMIT CONDITIONS O � �� <br /> � <br /> 1. All Ca115 for InspeCtion Shall be made 24 hrs. in ativance- phOne 259•881 5. p � <br /> 2. All work shall be performed in accortlance wRh Ihis permit and current City ol Everett Design and Consiruclion � �t p <br /> Standards and Specifications. � ^� <br /> 3. Call Location Underground Service aB hrs. betore you dig.TOLL FREE NUMBER 1-800•424-5555. � _ <br /> m � <br /> v <br /> � <br /> O �m <br /> C N <br /> / N <br /> m' <br /> > L1 // z � <br /> /Y.��}�/� .� m <br /> -� %`r �,��- � , � n <br /> ��.� }�- (/ � ` A <br /> / � � � <br /> �� , . ��I ..-: <br /> '� Ll _ � ��� n �`�yt'� . � v <br /> � �L:� O --I <br /> G� /�.tiz �� `�� ✓ ,S�.y�l = <br /> � - ,��ti � � � <br /> , <br /> ���� ���� � i°� .�'- �� J `�'"� � �,�- a z <br /> -���- -- �/,� � <br /> �,v y�+ '('� '�(- /J �, ./,-� t� /:. <br /> ��"'i `.�� � ✓ • . 1,.. .. J n <br /> m <br /> ,1 ACKNO�NIEDGEMENT OF CONDITIONS <br /> \S <br /> ,�t� The undersigned owner/apphcant hereby agrees to holtl antl save harm� <br /> less Ihe City ol Everett Irom any and all claims lor damages, costs. <br /> e.penses, o� causes ot action that may arise hecause of installauon <br /> . antl maintenance ol �he improvement or oiher right�obway use here�o <br /> apphetl tor antl luriher agrees to remove same upon no�me Irom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Daie — <br /> Approved as Cons�ructed Signature of Applicanl Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED bYITHIN <br /> everett PUBLIC WORKS DEPAFTMENT 180 DAYS OF DATE PEFh71T IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl.WA 98201 CANC[LLED BY THE GITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. <br /> ! <br />