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Date�� • a�m��werx�re,mu. v.�l .J — <br /> Applicatlon For emB o,o�.. �S� 90� <br /> PUBLIC WORKS PERMII• Puo.icWorAaFae <br /> Total Fee S <br /> LesaAOV�fea PnIE S <br /> Print or Type Only BelanceDue s ��GD <br /> �d 9 9�. <br /> C��c.cc_c..a Go,v�� / 9�P ¢9r,�- SCI� �J �B 3�' <br /> Owner Mailing�ddress City 2ip Phone <br /> �� I� L'�/t�= <br /> Applicant Mailing Address Cily Zip Phone <br /> Descnbe Proposed Work ��).r�L�s�'�� i ��. <br /> Project Address(il known) p��l� – < �� �Y - S L�%T 6' � <br /> Attach four(4)copies of plans for p�oa•,;ed woik• Draw to scale and nole ihe following as applicable: � <br /> • Property Lines • Centerline ot sireet � <br /> • Outline and dimensiaia o5 all existing and • Indicate North <br /> proposed structures un tY�e lo[ • Show any proposed grading changes <br /> • Existing and p�oposed�dilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls 1nr ir.spection shall be made 24 his. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with ihis permit and cwrent City of Everet�Design and Cons�ruction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. betore you din.TOLL FREE NUMBER 7•S00•424•5555. � <br /> !`.l �,l'C�Y✓iC /)E.3,c.s io !3E //�r c-t«/� U�{ e�� O <br /> �v,E'�(/Ei� lji�l-;ci.v�y; <br /> 5 I.vsre�- c- D,�i���<�ey C�%;��,�� �r sr���"r � <br /> i� yFcf'ss4,`f/ � <br /> �, ��tvE �5'���s L�u SiT` Sr� �is �t/oT O <br /> i'c� //hr�.4 C 7 i1'/2Td cl=i'✓,'/ GO TS �i�i Ti�� � <br /> /f 4i�J- %G;QTE.2 �'C/itJ 0� <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everetl Irom any and all claims lor damages, costs. <br /> ezpenses, i causes ol action that may arise hecause ol installation <br /> ��.T�� /y� ,� r and maintenance ol the improvement or other right�o4way use hereto <br /> '�'"` �"���`�C' r "� ` 7 aPPlied br and further agree; to remove same upon notice Irom ihe <br /> AGProved lor Consiruction Da!e Cily a t replace public properry damaged thereby. <br /> � J : , <br /> FINALINSPECTI N ��, Date �'/ ^l –�S� <br /> Approved as Constructed � r we of A 1 Date <br /> everett PUBLIG WORKS DEPARTME�iT WORK ,lUTHO E Y THIS PERMIT MUST BE STARTED WI7HIN <br /> � 3200 Ceda� Street 180 DAYS OF DATE PERMIT IS ISSUEU AND THEREAF7ER IS TO <br /> Evere'.t,WA v8201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLELI BY THE CITY UPON ANY STOPPA�E OF WORK ON 7HIS <br /> P70JECT OVER 90 DAYS DURATION. <br />