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i�ev�a.�r t vf'� <br /> Dat 0��� P�o�,�Wo,k,P<,m,. �f3 Uul _ <br /> Applitation For e�ap.Deot. <br /> PUBLIC WORKS PERMIT Publ¢Wo�kaFeo <br /> .��a�Fea s <br /> LessAopl.Fee Paia S <br /> Print or Type Only Ba�=�=Bo�e s ZO— <br /> �ue�at��coz-r ��o PF, ,�n�?�sry <br /> r'lark t�on�h�n r�rn C!��land A�c �v �c KBZo3 33a--35� <br /> Owner Mailing dress City Zip Phone <br /> Applicant Mailing Address City 2ip Phone <br /> Describe ProUosed Work _�(dl]OI,L A Id�rand Ma�l� �r� �1'aCYI f1/�Q�� �Of� <br /> �SZz� W <br /> Proj=ct Address(il known) 7la�Z c)n11f}A!� �(i _ � <br /> Attach tour(4) copies of plans for proposed work• Draw to scale and note Ihe tollowing as applicable: � <br /> • Property Lines • Cenlerline of street � <br /> • Oulline and dimensions oi all existing and • Indicate Norih <br /> proposed structures on Ihe lot • Show an�proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DU NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shell be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordence with this permit and current City of Eve;^�t f;asign and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-q2q-5555. � <br /> h, 1�5t��� G''�ion Go��✓o) Ayc4i✓�%� I� (?vl�l;� IAIo�Kc (;�qs�i:�ri�! <br /> (�n;s L� ►.��^ 33a- 7¢�.��i � <br /> � <br /> � <br /> � <br /> � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The undersignetl owneUapplicant hereby agrees to hold antl savc hanm <br /> � less the City ol Everett Irom any and all claims Iqr damages. costs <br /> expenses. or causec ol action that may arise because of installation <br /> � L�� O and maintenance ol the improoement or other right-oFway use herelu <br /> applied lo� and furiher agrees to remove same upon notice from ihe <br /> Approved lor Constr�ion � Ciry�nd to replace public proper�y damaged thereby. <br /> C-- �� �- �= . _ /—iU— 9� ����!—t-!ml��-- ��' �y <br /> FINAL INSPECTION� / � Date <br /> Approved as Conslructed Signature ApplicaN ` � D� <br /> �A�'�� PUBLICWORKSDEPARTMENT WORK AUTHOFI2ED BY THIS PERMIT MUST 5E STARTED WITHIN <br /> � 3200CedarSireet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> �� BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> ,� Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WURK ON THIS <br /> Phone:259�BB10 PROJECT OV[R 90 DAYS DURATION. <br /> �sr.' <br />