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5 /r �- <<8 � � <br /> Date� PubLCWo�ksParmi�• '—�✓� <br /> Application For eiaa.oen��• �/� <br /> PUBLIC WORKS PERMIT °°°�°W°,k,FeB -- <br /> Tolal Fee $ <br /> Less AppL Fae Paitl 5 <br /> �Q�O <br /> Print or Ty�e On�y ea�a��ao�� s <br /> �Ca�-fcar �. n,n (��1 . ; ; '� L1)�,/'.�12�l�9 �i/P/E /�- �✓�i- c(SZC�= c�ZS.� -�/7vZ3 <br /> Ovmer Mailing Address Cily Zip Phone <br /> Sa r� -� <br /> Applicant MailingAddress City Zip Phone <br /> DescribeProposedWork _�Pul �' �NGl� iI�u 1'Y�P/�FN�� <br /> �N� (1 'EI�NI�/.'v��7� /'�iI.�S '-�` S <br /> �7 - 1 � W <br /> Project Address(il known) orJ���' v/�LcIC'.fx'Si� �UE. � <br /> A�tach lour(4)copies of plans for proposed work- Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline ol�Ireet � <br /> • Outline and dimensions of all exisling and • Indicate North <br /> proposud s�ructures on ihe lot • Show any pruposed;�ading chan9es <br /> • Existing and proposed utililies • Show measuremei�ts � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t. All calls fcr inspection shall be made 24 hrs. io advance-phone 259•881 5. � <br /> 2. All work shnll be perbrmed in accordance with ihis permit and current Cily of Everett Design a.id Conetruction <br /> Standards ar�d Specilications. <br /> 3 Call�ocation Undeiground Service 48 hrs. bebre you dig.TOLL FREE NUMBER 1-800•4't4•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> /[r ACKNOWLEDGEMENT OF COk01TIONS <br /> a����r ` The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less lhe City ol Everett from any and all claims ter damages, cosis, <br /> �i��l�!/U �lTL>/-d7r expenses. or causes of nction ihat may arise becaus.: ol insiallation <br /> and maintenance of the improvement oi other ri�ht-ol-way ::^� hereto <br /> applied for and lurther agrees �o removc same upon notice fron, the <br /> Approved fo onsirucf Date City and to replace publicproperty damaged thereby. <br /> i � <br /> 9�2`�-f) �,� <br /> FINAL INSPcCT10N Date -- � ` _,_ G' /O �-��"7 <br /> Approved as Construcled Si naWre of H��nlir,ont Date <br /> evere!t PUBLIC WORKS DEPARTMENT WORK AUTHC �I7ED�BY THIS PERMIT A1U5T BE STAqTED WITHIN <br /> � 3200 Cedar S•reet 780 DAYS OF DA?c PERf.AIT IS ISS_�F.D AIJD iHEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO CCMPIL-TION. THI� PER�AIT MqY BE <br /> Phone: 259-BB15 CANCELLED BY THE GTY UPOP�.�NY STOPPAGE OF WUFK UN THIS <br /> PROJECT OVER 90 DA1'S GURA?ION. <br />