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�q. _3�'i <br /> Date L�/ � �'�'G P�n�<<�o,��ae�m,�. �a <br /> � eiap oeoi-� <br /> Application For <br /> PUBLIC WORK$ PERMIT vu�TotelFeaFee s <br /> ��ss non�Fee ae�e $ <br /> oaience oua g <br /> �%e'=� <br /> Frint or TyFe Only <br /> �r�aEes�� ` .n 243oc� 4d� qu.�n1, rH�t. q�oE3 339-ssv� xz�� <br /> Owner Mailing�ddress City Zip Phona <br /> Applicant Matling Address C�ty Zip Phone <br /> DescnbeProFesedN'ork ���F�LL �j(Z �{�(ZQ[�� SLAB +' F�J^I� OF ���KSL <br /> W <br /> Projecl Address 1if known) ��� C W ��1��' � <br /> Altach lour(4)copies of plans lor proposed work- Draw to scale and note ihe lollowing as apUlica6le: � <br /> • Property Lines • Centerline of street � <br /> • Uutline and dimensions of all eaisting and • Indicate North <br /> proposed strucWres on ihe lot • Show any pwposed greding changes <br /> • Existing and proposed ulililies • Shcw measuremenis /�A <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS <br /> t. All calls for inspection shall bs made 24 hrs.in advance-nhone 259•881 5. � <br /> 2. All w�rk shall be performed in accordance with ihis permit and current Ciry ol Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Servicr 48 hrs. before you diy.TOLL FREE NUMBEH 1•800•424•5555. � <br /> O <br /> � <br /> OB/04/86 1:�1FN OOORq?27 � <br /> / OCHECf; 420.(kl <br /> a <br /> ACKNOWLEDGEMENT OF CONDITI::�JS <br /> ihr undersic�netl o�vner/appllcant hereby agrees to hold anA save harm- <br /> less the Ci1y of Everett Irom any and all claims lor damages, costs, <br /> expenses, or causes of action Ihat muy arise because ol installation <br /> -� L� and maiMenance ot the improvemenl or olher right-of�way use hereto <br /> � -�� �l —�'6 applied fo nd Wrther agrees to remove same upon notice Irom the <br /> App vetl or orist ' io Date Cit d t r lac p�lic property damaged ihereby. <br /> �1� �'ai��6 c Sszi g-Y-B� <br /> FINAL INSPECTION Date <br /> Approved as Constructed Sig ature ol Applicanl Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcrett PUBLIC WORKS DEPARTMENT 7B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedzr Sireel BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORN ON THIS <br /> Phona 259�BB15 PROJEi,T OVER 90 DA1S DURATION. <br />