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� <br /> � <br /> � <br /> � <br /> � �y � ' <br /> Date �_��—� PuUI�G Worke Permil� �— <br /> BIC9.UeGt.• � <br /> Application For � <br /> PUBLIC WORICS PERMIT `°°TOWF�aFaa S � " � ' <br /> Le+e ApP�Fee Peitl S � <br /> Balance Due S � ' � � <br /> Print or Type Only ('c�:-�e[a<�#G7GC�s�yi' , <br /> J�N�v� 5. r?-0u�JSa,� <br /> V�c.,�� L. �DSGN� �307 �'V1�.;�a �/Pre� `IX�D ! a68 - c��1�o <br /> Owner Mailing Address Cily Zip Phone , <br /> ��GKi L r2D`iCN��I �3�7 �'Vtic.nlr C�c�etl" `Ib's'D f ,�SH - (�`j/p � <br /> Applicant Mailing-Ad��ess � �i�Y ZiP Phone <br /> i �� �- <br /> Describe Proposed Work O �- '���Z UT ��e G !Pif 4 <br /> ` � � � a� G <br /> � ��,. v CpCt�B +1' � 7 SGur c <br /> < < <br /> h� �e���h W <br /> Pra�ect Address(if known) ��%" ue '��� ���D I � � <br /> Attach four(4)copies of plans for proposed•Hork• Draw to scale and note tho following as applicable: � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions ot all existing and • Indicate North � <br /> proposed structures on lhe lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Show measurements M , <br /> W <br /> DO NOT WRITE BELOW THIS LINE <br /> O � <br /> PERMIT CONDITIOC�S ' <br /> 1. A�I calls lor inspection shali be made 24 hra in advance• phone 259•881 5. � i <br /> 2. All work shall be pertormed in accordance with this permit and current City oi Everett Design and Construction , <br /> S�andards and Specillcatio�s. , <br /> 3. Call l.ocation Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � , <br /> O � <br /> � � <br /> � � <br /> O <br /> a ; <br /> ACKNOWLEDGEMENT OF CONDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold and save harm• �� <br /> / less the City of Everett irom any and all cleims for dameges, costs, , <br /> �� , �� expenses, or causes oi action lhat may arise because of installation � <br /> �/ �-J �� �� �2�_�, and meintenance of the improvement or other right-ohway use hereto <br /> / � applied lor and further agrees to remove same upon notice from the � <br /> �pp�ed tor Construction �a�e Ciry and!o replace public property damaged thereby. i <br /> ������- r�-�-y �--,�f �--��'� � <br /> FINAL INSPECTION pate 2�� ?Z)�G�_ <br /> Approved as Constructed Signature of Applicant Date � <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLEI�ION.THIS PEfiM1T MAY BE � <br /> Evcrelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS � <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. � � <br /> 1 <br /> i <br /> 1 <br /> j 1 <br />