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� <br /> r-� - <br /> '�(!�.p� Puo'�'�c P:c•xs Pcrm��t� <br /> Date—'' F� Bitlq Deo�� <br /> Application For <br /> PUBLIC WORKS PERIVIIT' PubTotalFeaF`� 5 <br /> Less Aoo��Fee Paie S <br /> Balance Oue $ <br /> Print or Type Only <br /> �7 N' � ri , ` i�, 1.d/t f'liG;' !%/�1" �=5%lVt+',i,%lTlS�,y'. '.�.�i��3 �S�-�3.�2. <br /> i �i! J�� '.�� i �/C�%f-L/_�r����� Phene <br /> Uwner <br /> Mailing Aadress City Z�P <br /> � —J��3 <br /> /� r Go,^��T. C 0� _ ._2 S,'��i.->' �=�r=�.,� .,��,T °%<� � '�- s.:�`� <br /> `�c�{v iF-cK� ,�5 . <br /> . qpplicant <br /> Mailing Address City Z�� <br /> ' � �' r ' s."C�T'/�������� <br /> Describe Proposed Work <br /> S�I' �i r 1_� r-.^:'r�,. _ f� N�J�'-•?��-`�C" e`? _ <br /> �� �;v,�b. .��� <br /> � <br /> � ' H__ ':�i�G� � V/ .C\!�/ �'/'�'G.S.%� �• �/'�-'.- ..j�('f�� <br /> Project Address(il known) _ " <br /> � <br /> Attach four(4)copies ot plans br proposed work- Draw�o scale and nole the lollowing as applicable: � <br /> • Properry Lines • Centerline al street <br /> • Outline and dimensions ol all enisting and • Intlicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measurements � <br /> 00 NOT WRITE AELOW THIS LINE � <br /> PERMIT C(1NDITIONS � <br /> 1. All calls tor inspec�ion shall b��made 24 hrs. in advance-phone 259�881 5. <br /> 2, All work shall be pertormed ir� accordance with this permi�and wrrent C�ly ol Everett Design and Construction <br /> Standards and Specificalionr. � <br /> 3. Call Location Underground Servico 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424•5555. <br /> V�� �,( . , . -. . ,- � . <br /> U `�'^��� �� \ ��/� <br /> .,\ ? ,, ` V� <br /> `\, , O <br /> ��� ��� , 7, , <br /> , , <br /> i� <br /> � � a <br /> , <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �. The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from any and all claims for damayes, costs, <br /> expenses, oi causes ol action ihat may arise because ol installalion <br /> � and main;enance of the improvement or other right-of�way use hereto <br /> appiied for and tcrlher agrees to remove same upon notice Imm lhe <br /> ��, Approved br Consiruction Dale City and to replace public property�+emaged ihereby. <br /> FINAL INSPECTION Date -- Dale <br /> � Approved as Constructed Signature o1 Applicani <br /> WORK AUTHGRIZED BV THIS PERMIT MUST RE STARTED WITHIN <br /> everet[ PUBLIG WO(?KS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet I BE DIUGENP Y PVRSUED i0 COMPLETION. THIS PERMIT MAY �� <br /> Evere�t.WA 98201 CANCcLLED BY THE GTY UPON ANV dTOPPAGE OF WORK ON THIS <br /> Phone: 259-8615 PROJECT OVER 90 DAYS DURATION. <br />