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_.,� <br /> �; <br /> . . J�:R l"..i . <br /> ;;a <br /> � ,_., , /��t <br /> Date�}�, P�o�,�wo,�s P��m,g� <br /> Oiap �epi • <br /> Application For <br /> PUBLIC WORKS PERMIT Pu�TotalFeaFeo g <br /> Lose�p0�Fee Pmtl S � <br /> L'J C7� <br /> Balanco0ue g <br /> Print or Type Oniy <br /> ,o�ax <br /> >yv�i ��/� f�� �,� <br /> � �n � Owner ��' �[Maili�ess � � � I ��Y Zip Phone � , <br /> H�1 r� �{ //�/�t/� <br /> "�fJ H"'O+J � ��I �1\ J 1 C � ( / A I�J <br /> y�"� pPp���a�� MaJing Address Cdy Zip Phone <br /> z e-� �f'� <br /> � y� Descrit�e Proposed Work �=—��r ' � ���1 — <br /> � �g <br /> �� � <br /> � � <br /> H � <br /> yH <br /> r ~y � � <br /> g U� Prolect Address(if known) <br /> H <br /> C7 C7 fl� � <br /> Attach lour(4)copies ol plans for proposed work-Draw to scale and note the following as p icable: <br /> r <br /> • Property LineS • Cen�edine ol Street ♦^ <br /> � <br /> O Outline and dimensions of all exis�ing and • Indicale Nodh <br /> yO(A proposed siruclures on ihe lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> � 1.All calls for inspection shall,�e made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permil and current Cily 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 /> %O-/d-86 <br /> � ,__.� � ��1�re� G��� p <br /> __ <br /> � � <br /> __ � <br /> � � .. <br /> Imf 1 � � F S � <br /> �;l :. <br /> ��:, 0. <br /> 1�� _ <br /> ACKNOWLEDGEAIENT OF CONDITIONS <br /> � The undersigned owner/applicant hcreby a9rees to hotd and save harm- <br /> �� � less the Ciry ol Everett Irom any and all claims lor damages, costs, <br /> ezpenses, or causes of aclion that may arise 6ecause of installation <br /> and maintenance ol lhe improvemenl or other ngM-ol-way use herelo <br /> applied for and lurther agrees lo remove same upon notic� Irom Ihe <br /> .���i Approved for Construction Date Ciry and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construded Signature ol Applicant Date <br /> WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT tAU DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evere�t WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 pqOJECT OVER 90 DAYS DURATION. <br />