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i <br /> ! <br /> Date�/�"� �uLs WorksPeimit� _ ���2/8 <br /> AppliCation For eiae�oeo�.• _�tQ�_t_I/—� <br /> F'�JBLIC WOF�KS PERMIT �°�°°W°��=F�° -- <br /> Tofal Fca s- <br /> LessAp01 FaePaid $ � <br /> Bairnce0un � �O� <br /> Print or Type Only <br /> �n�n ,� �i � �v BcY /a4 � M„�•,1L�.�`�R a�s � y � - 3��,r _ <br /> Ownvi- �dailing Add ess City Zip Phone <br /> SA p iCanl Mailin�Address City Zip Phone <br /> Describe Proposed Work Jzl r,P 1 �MA,yt(� �- _ _ <br /> Projecl Address�il known) �7U' I UJ Iba A�. FWQ.. � <br /> � <br /> Attach lour�4)copies ol plans br preposed work- Draw to scale and note the lollowing as applicable: �� <br /> • Property Lines • Centerline ol sireM � I <br /> • Outline and dimensions ot all existing and • Indicate Norlh <br /> proposed structures on fhe lot • Show any proposed gradinc�changes � <br /> • Ezisting and proposed utilities • Shnw measuremenfs �� <br /> DO NOT WRITE BELOW THIS LWE O I, <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shell be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be peAermed in accordance with Ihis permil and cunenl Gily of Everelt Design and Construction <br /> Standards and Specificaticns. <br /> 3.Call Location Underyround Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•Q24•5555. � <br /> O <br /> �w <br /> _/ ' <br /> O <br /> � <br /> ��uo� <br /> � ACKNOWLEDGFMENT OF CONDITIONS <br /> �,�- The undersigned owner/applicant hereby ag�n,es to hold and save ha�m� <br /> less the City of Everett irom any and all claims for damages, costs. <br /> � A expenses, or causes ol action Ihat may arise because of installation <br /> Ai/� � �f�i�._��J_� and maintenance ol Ihe improvement or other right�ol�way use hereto <br /> �vG UU7 y applied for and luriher a9rees to remove same upon notice Irom ihe <br /> Approved lor Constructi Date Ci and t /replace public proper m ed Ihereby. <br /> � '� — L�-�P �/� � d o <br /> �;NAL INSPECTION Date � <br /> .'�^nroved c��onslruCted gnal re ol Applic nl �—� � Date <br /> everett �I1BlICWORKSDEPARTMENT WORK AUTHORI ED OY THIS PERMIT MUS BE STARTED WITHIN <br /> � 3200Cr,�larSlreet 180 DAYS OF ATE PERMIT IS ISSIJED A D 7HEREAFTER IS TO <br /> Everett,WA9d201 8E DILIGENTLV PURSUED TO COMPLETION. THIS PERM�T MAY B[ <br /> Phone:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />