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� <br />� <br /> f <br /> I <br /> I PuOft Worka Permd s //�� I� <br /> Date�L�.�3 <br /> eiaa.oco�.+— <br /> qpplicaqon For <br /> PUBLIC WORKS PERMIT P��toWa'k��Fee � 1,,, �, � <br /> Less AOP�Fco Paid $ — <br /> BalanceDua S'�� � �� <br /> Print or Type Only 6t<�— <br /> �-� dill�� c� �'UP �" - `J�7J <br /> C ?eU �ecdi2 ..�c/ ��tJP,�J d ��0/ �P�e - <br /> Owncr Ma�ling Address City P <br /> h� c CRJ�PU / /�M(' S' � � �'7.3��. _ �UL'�2e 1� �'l�vU�GL� ...3�s� �(=, D(7 <br /> Applicant <br /> Mailing Address City ZIP Fhone <br /> . <br /> 0 <br /> Describe. Proposed Work <br /> W <br /> Project Address(if known) /O� � � e �� � <br /> �� <br /> Attach four(4)copies of plans tor proposed work-Draw to scale and note the fcllowing as applicable: � <br /> • Property Lines • Centerline of street <br /> • Oulline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Shn�v any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be mnde 24 hrs in advance- phone 259•881 5. <br /> 2. All work shall be parformed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you diy.TOLL FREE NUMBER 1•800•424•5555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACK�OWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrecs to hold and save harm- <br /> less the City of Everett trom any and all claims tor damages, costs, <br /> expenses, or causes ot action that may arise because of instellation <br /> ��–���C��/.�?�- and maintenance ot the imProvement or other righl-of•waY use hereto <br /> � �� j applied lor and lurther agrees to remove same upon notice irom the <br /> —�- Date City and to replace public property damaged thereby. <br /> ApproveU tor Conslruction <br /> ���� s/..��� _r'�-� �� �. G% ��-�'� / G �� <br /> �AL INSPECTION Date �__ Date <br /> Approved as Constructed Sig iature of Applic2nt <br /> WURK AUTHnRIZED BY THIS ERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE— <br /> Everelt.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> 1 <br /> d <br /> 1 <br /> � <br />