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�pp�/ � �� <br /> ��� P�ercw/ �.��, � <br /> DateL� eieo oeo� • <br /> ppplicatlonFor Pup�iGK'orksFee S _J�p`�' <br /> PUBLIC WORKS PERMIT Ta,a�Fea <br /> �eas AOV�Fee PeiE S� <br /> eai.��e o�a <br /> 3 ����— <br /> Print or Type Only ,(ct'T_ G 47a'� <br /> � 2�� sa�a�a � <br /> , • �,,�x,�� /030/�'t� � s c.10-�i� ir/n. <br /> � CiIY ZiP Phone <br /> . Meilin Address <br /> ner <br /> � [;!/' , ���� CitY Zip Phone <br /> Applicant Mailing Address <br /> �..C� 9'u�� /G U ���' �D�' — <br /> Describe ProPosed Work � <br /> ��v� /�I�,�� � W <br /> �70� �/y l���,..,.�� �` ' �' <br /> Project Address iif known) � <br /> Attech four(4)copies of plans for proposed work- Draw lo scale and ' �te the followin9 as applicable: � <br /> - • Ceiderline of sireet <br /> � property Lines ♦ Indicate Ncrth <br /> • Outline end dlmensions of all exisling and � Sh�w any proposed grading changes � <br /> proposed slructures on the lot � Show measurements <br /> • Existing and proposed ulililies <br /> DO NOT WRITE BELOW THIS I.INE O <br /> PERMIT CONDITIONS hone 259•8815. � <br /> 1. All calls for inspection shall be made 24 hrs. in advance• P <br /> 2. All work shall be pertormed in acwrdance with this permit and current City of Everett Design and Construclion � <br /> Standards and Specitications � <br /> 3. Call Location Un�erground Servica 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �-S C��J/T�viJ.s c�/� O � <br /> h <br />, � /�/�'�� ��v��� �,� ir107� c/�f'�l.y�_ <br /> ��� ~�/� <br /> V♦ y � <br /> O � � <br /> v� _ <br /> a � � <br /> � � <br /> �-. <br /> � � <br /> ACKNOWLEDGEMENT OF CONDITIONS � .- <br /> The undersigned owner/applicanl hereby agrees to hold and eave harm- � <br /> less the City ot Everett irom any and all claims lor damages, cosls. H <br /> expenses, or causes of action that may arise because ol installation <br /> � r <br /> and maintenance ot the improvement or other right•ohway use herelo � i. <br /> _� ���� applied lor and lurther agrees to remove same upon notice Irom the <br /> �� � Dat� CitY and to replace public proPerty damaged thereby. � , <br /> pfoved or nstruc � ��� - <br /> � .�% _�" ' ` 3/� � �-r Q ' � : <br /> - Date ` � � ate <br /> �FINA� INSPECTION Sig t � P'�a^� <br /> Approved asConstn�cted y�r RK A THORIZED BY T IS PERMIT MUS7 E STAR7ED WITHIN � - <br /> PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br /> evemtt gE DILIGENTLY PURSUED TO COMPLETION, THIS P[RMIT MAY BE <br /> � 3200 Cedar Street <br /> Everelt.WA 992�1 CANCELLFD BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8915 PROJECT OVER 90 DAYS DURATION. <br />