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Date�� ' � Bcg— 2 <br /> Publ¢WarMs Permll+ <br /> Applicalion For gme-oer�� <br /> PUBLIC WORKS PERMIT /u�toWFeerec S <br /> • <br /> Less PpO��Fee Peid S <br /> Balenca Due S ����— <br /> Print or Type Only <br /> ��w�,-i: ��s PQt�rn��1�P � /�x ��5� �DrrL� �80�0 <br /> Owner Mailing Address City Zip Phone <br /> S 71�/-�'71� <br /> Applican Mailing Address City Zip Phone <br /> Describe Praposed Work ���r� �T�r����T �l��� � � ��"� � — <br /> —�F�� �m�n rT- F c,4SS. <br /> 7/7 Q W <br /> Prolect Address(if known) -' r '"�'r'�`-�—"" H <br /> Attach four(4)copies o(plans for proposed work- Draw lo scale ard note the following as applicable: � <br /> • Property Lines . • Centerline of street � <br /> . • Oulline and dimensions ot all exisliog and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> � Existing and proposed ulilities • Show measurements M <br /> W <br /> �� DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> • 1. All calls far inspectlon shall be made 24 hrs in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> '� S��' u>i�2e To BE I�cw�' P.�,e .q.o,�o��o � <br /> i�C•9•rJS .c�F�'rE v 3—/� —RB , <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 Cily of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise because of installation <br /> � _ _ L ? � B and maintenance of the improvement or other ric�ht-ol�way use hereto <br /> ����s'� �J applied for and turther agrees to remove same upon notice from ihe <br /> Approved for Const ction i a�e Ciry nd o repla pu lic erry damaged thereby. <br /> � � ,�%� ��r�s 1 . <<,� <br /> FINAL INSPECTION a1e <br /> Approved as Constructed S tur of Applicant Date <br /> WORK AUTHORIZED BY THIS PER MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DAYS OF DATE PERMIT IS ISS ED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> EveretL WA 98201 CANCELLED BY THE CITY UPpN ANY STOPPAGE OF WORK ON THIS <br /> Plione: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />