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Date `�"�'���� �y <br /> • � � Poohc wmws ve,� / �� <br /> Application For � �--� <br /> BI�B.Dapl.s � <br /> PUBLIC WORKS PERMIT P�o���W„k.Foa ' - <br /> Tolal Fee S�- <br /> less Appl.Fee Paid ���_ <br /> Print or Type Only e��r�«o�� g�_ <br /> �----� <br /> r11�' `�`�� �'Y`� ��7 � �i '�1 �7 ,�7 �,��/� <br /> Owner /�— -/ �1� �1 ( �(`_ I� �r F'r�` l �L�C '� <br /> Mailing Address City ��� � <br /> Z�P Phone <br /> Applicant Mailing Address � ✓—��� / <br /> /� ���Y Z'p Phone <br /> Describe Proposed Work _ �_>��I'� ��(:�'� � ��I'� <br /> Project Adtlress{il known) � � '�1�}� J r- � <br /> !� �Attach four(4)copies ol plans lor proposed work� Draw to scale and note Ihe lollowing as applicable: <br /> • Property Lines • Centerline of street — <br /> • Outline ard dimensions ol all existing and � <br /> prOposed structures on Ihe lot • Indicate North <br /> • Existing and proposed itlilities • Show any proposed grading changes <br /> • Sl;ow measurements <br /> DO NOT VJRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspection shall be made 24 hrs.in advance•phone 259-gg1 p. <br /> 2.All work shall be performed in accordance with ihis permit and current City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.before you dig.70LL FqEE NUMBER 1-$00•QQq-5555. <br /> No �ur�� ic. IVd� K� �E�r�tcr f�EQuie�,-� Z <br /> �--�.�.l�, ►�'l�i�.a_. Q <br /> � - �3-�o I— <br /> � <br /> �N �T� . �P�T j'� ft.T I Ot�l OF SEIYE�'� O <br /> g c � N ��... ,� ��-� � M�S�- a <br /> 1v1 E E T- P L �) A'1 tj I t�U G O 1�E . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ac�rees�o hold and save harm� <br /> less the City ol Everetl Irom any and all claims lor damages, costs, <br /> expenses, or causes ol action ihat may arise because of installation <br /> and maintenance ol the improvement or other right�of-way use hereto <br /> Approved for Construction p��e applied lor and fur�her agrees to remove same upon notice Irom the <br /> Cily and to icpiacc public property dainaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Sipnatwe ol Applicant <br /> Date <br /> everett PUBLIC WORKS DEP,4NTMENT WORK AUTHOR12E0 BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98701 BE DILIGENTLY PURSUED TO COMPLETION. 1HIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> L <br />