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�.. <br /> , � <br /> . �� <br /> Date s/ r3 � �� � <br /> Pu01ic Worka Parm.�s <br /> Application For ein� n.n� + S-3 /�O 6 <br /> PUBUC WORKS PERMIT PuelicWarksFee ,� �� �— <br /> Teiel Fee S_. <br /> LE69 RpDL FCe P9id S <br /> , Print or Type Only e.�a��e o�a S ' � — <br /> �7'�!°,�.e i...� ?�TF '.v s izi/ � �.1.�- 1+.lt � �iJ��T/ 4�1-/� � 3 S3 l�{'/ <br /> Owner Mailing qddress ity Zip Phone <br /> ,V �� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Praposed Work ���"-� � T�r+/ � / <br /> Project Address(if known) �•7 .L . � <br /> r ; � <br /> Atlach(our(4)copies of plans lor proposed work- Dra� t scale and nole the(o�wing as applica6le: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimersions of all existinc�and • Indicate North <br /> p�oposed s�ruclures on the lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show measurements � <br /> UO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with Ilils permit and current City ol Eve�ett Design and Cnnstruclion <br /> StanAards and Specilications. <br /> 3. Call Location Undeiground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555, � <br /> O <br /> � <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OFCONUITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> �—' — less the City of [vere!t from any and all claims lor damages, costs, �1 <br /> expenses, or causes of action ihat may arise because of in,tallation <br /> �,/. S �� and maintenance of the improvement or other right-oFway use hereto <br /> apptied lor a d luriher agrees to remove same upon notice Irom the <br /> A ed for Constructicn Date City and to place public property damaged thereby. <br /> . /' ', <br /> /�-9-�'� � <br /> FINAL INSPECTION pa�n / 7 <br /> Approved as Construded .,ignature of Applican Dale <br /> �verett PUBLIC WORKS DEPAFTMENT WORK AUTHORIZEC BY THIS P�. IT MUST BE STARTED WITHIR <br /> � 3200CedarStree� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere�t,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone: 259-0815 CANCELLED BY THE CITY UPON ANY Sl OPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. ) <br />