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Date. �h S v�ei��wo,k:v�,m��i. A�7 <br /> / / <br /> Application For ��w��c=' — _ <br /> PUBUC WORKS PERMIT P����=W�,�•F�e — <br /> Total Fee S__ <br /> Le5>ACG��Poe PaiO $ <br /> Print or Type Only Baa�=,o�e s ��-OC� <br /> 1 (7'i.�;�� �/v��7 C S'�71 �T / �� / V ; C"_ U✓ �J/�' C ✓l a-f l '�— �y�, <br /> Owner Mailing Atldress City Zip ' Phone � <br /> - �j �[P �(,' '7 t�'tii r � `� �C1,j� l*1 <br /> �L l ��! <br /> Applicant Maihng Atltlress �,,� itQ y Zip Phone � <br /> Descri6e Proposed Work �rn S� / d F-L— /�C / / �C '� �."�/�'1� �_'� 7 f�ii•t <br /> � <br /> N <br /> H '*1 <br /> M �] <br /> � � <br /> Project Addre55(il known) Q w � M <br /> Attach tour(4)copics ol plans for proposed work-Draw to scale and note the Iellowmg as applicable: � � � <br /> • Property Lines • Centerline of street /w � <br /> • Outline and dimensions of all existing and • Indicate Norlh V� M <br /> proposed siructures on the lot • Show any proposed grading changes rJ Z <br /> • Existinp and proposed utilitit^ • Show measurements y <br /> UO NOT WNi i E a�LC.'!TI!I,9 L!NE � H Is~!1 <br /> O K <br /> PERMITCONDITIONS 0 � <br /> t. All calls lor inspection shall be made 24 hrs.in advance- phone 259•881 5. � � <br /> 2. All work shall be performed in accordance with this permit and current Ciry ol Gverett Desipn and Construclion <br /> Standards and Specilications. H <br /> � <br /> 3. Call Lotation Underground Service 4D hrs. befo�e you dig.TOLL FREE NUMBER 1-800•424•5555. � � <br /> � N <br /> O , � <br /> � � <br /> � y <br /> O � <br /> N <br /> a � <br /> Hn <br /> �7 <br /> I n�.i.n.������L��l i�i:T.�'�.',��I(`�T�i�tl^ <br /> �l� rV <br /> _i� The undersi9ned owneUapplicant hereby agrees to hold and save harm- <br /> less the City ol Everett Yom any and aIl claims for damages, costs, <br /> ' � �s expenses, or causes ol action that may aris� beca�•se ol installation <br /> '� ^ �PD�� c7 �� 85 and mainlenance ol the impwvemenl or other right�ol-way use hereto <br /> applied lor and lurther aqrees to remove same upon notice irom the <br /> Npproved for Constri�ti Dale Cily and to replace public property tlamaged thereby. <br /> /� / <br /> !—�3•��+�-- y—w —F� ;�, �� ������ � , r�� , <br /> FINA�L IN1 PECTION Data � � � ��`� � � <br /> Approved as Constructed Signature of ApplicaN � i , pate <br /> r�crett PUPLIC WORKS DEPARTMENT WORK AUTI�iORIZED �Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 CedarSlreet 180 DAYS OF DAT[ PERMITIS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENT�_Y PURSUED TG COMPLETION. THIS PERMIT MAV BE <br /> Fhonc:259�8(315 CANCELLEC BY THE CITY UPON ANV STOPPAGE OFINORK ON THI� <br /> PFiOJ[C,�GV[R 90 OAYS DURATION. <br />