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Date�l3�d 8' �? 3/� <br /> Pu01¢Works Permi�• p. <br /> Appllcation For ome�oeo�.•__—B p7�.2Q�F�Z <br /> PUBLIC WORKS PERMIT Pu�i¢WorkaFee <br /> Talal Foe S <br /> Less ApPI.Fee Paid .S <br /> Print or Type Only ea�a�=�o�e s z� <br /> -7 1 <br /> �- �S i 2 tt a 9 S a�a�E .,��/ � �a s�/e �Y.rr e � �42 0! <br /> Owner Maifmg Adtlress ^—� City Lp Phone <br /> /7�r,� �Th �m -%� 5??f �/r42 L� S%rr�Hs 94�s'v 37'4' 93'/6 <br /> � Apphcant O Mailing Address Gry Zip Phone <br /> Describe Proposed Work �'� �va r T pi�!ye 1qi q V <br /> � <br /> I <br /> � W <br /> I Project Address(if known) '.�5�D'3 l�'(4-f71 e �„Q r e r7` � <br /> i '__' <br /> Attach four(4)copies of plans for proposed work• Drew to scale and nole the following as applicable: � <br /> • Property Linr.s � Centerline of street � <br /> • Oulline and dimensions of all existing and • Indicate North <br /> proposetl structures�n the lot • Show any proposed c�rading changes <br /> • Existing and pruposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspectlon shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in acwrdance with this permit and current City of Everett Design and Construction ' <br /> Standerds and Specifications. <br /> 3.Cal�Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> Ch'.e,� r Z <br /> �" �.�,9c,�' /8'6 " of'f' O <br /> Tirfi� 2��'Sf. /PL.�G�• /�S' S/S�oc�.u/ L�.d /`H.a=.9�?AC/�O �5'iJ"�/rrZ'y <br /> � <br /> � <br /> O <br /> a <br /> ACKh'pWLEDGEMENT OF CONDITIONS <br /> The undersigned owneUapplicaM hereby agrees to hold and save harm� <br /> less the City o� Evere�t Irom any and all claims for tlamages, cosls. <br />� oxpenses. or causes ol action that may arise because of installation <br /> / 7�9 8 and maintenance o� ihe improvement or olher right�obway use hereto <br /> Approved for Con� ti n a�� applied lor and further agrees to remove same upon notice irom the <br /> City antl to replace public property damaged thereby. <br /> /'-�._��� � J . <br /> FINAL INSPECTION p�1e � , 7�� �� <br /> Approved as Constructed Siynature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TH PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />