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,,,, <br /> Date 7/�Pl � <br /> Pu�LG WorAs Permil+ t� <br /> ApplicationFor eieg.ocoi.= �_.Z, �RJ�37 <br /> PUBLIC WORKS PERMIT Public\YorksFee , / <br /> ,a���Fae s _ <br /> Lesf Appl Fea Paid g <br /> Print or Type Only ea�a��eo�� S <br /> 1 � S ��u��( � /nn��?u��- p� ��ii�n� l-� �i�il� yR �o � �-'-5 Z -�Z.G <br /> Owner MaiGny Address Cit <br /> 1� ZiP Phone <br /> S'u v�e <br /> Applicant Maihng Address City Zip Fhone <br /> Describe Proposed Work �P rNnl� � ��(��___����('p�� �j �/�i I� /�!'GJ 1t �Q <br /> �—T � — <br /> Project Address(il known) � <br /> Attach lour(41 copies ol plans lor proposed work- Draw to scale and note the followiny os applicable: � <br /> • Property Lines • Centerline of street � <br /> 4 Outline and dimensions of all existing and • Indicale North <br /> proposed strucWres on Ihe lot • Shpw any proposed qrading changes <br /> • Ezisting and proposed utilities • Shr.w measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT COIvDiTIONS � <br /> 1. All calls for inspec�ion shall be made 24 hrs. in advance- phone 2S9•S$1 5. � <br /> 2. All wcrk sha�l be peri,rmed in accordance wi�h this permit and current City of Everet� Design and Consiruclion <br /> Standards r.nd Specilications <br /> 3. Call Locati�n Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �G l�GiC l�JO,�'.�S /`c-;r'�iiT /l/lJT � � l � <br /> �(�'ca Ui,LFO 7�j�B / O <br /> ���, <br /> � <br /> � <br /> O <br /> a <br /> ACKNON`LEDGEMENT OF CGNDITIONS <br /> _ _ The u�dersigned owner/applicant hereby agrecs to�old and;ave harm� <br /> less Ihe City ol Everetl from any and all claims tor damages, costs, <br /> expenses, or causes of ac�ion lhat may arise becouse of installation <br /> and maintenance ol ihe improvement or other righbof-way use nereto <br /> ApPro;�:o for Construction Date applied lor and Inrther agrees lo remove same upon notice Irom the <br /> City and to replace public properry damaged ihereby. <br /> FINAI INSPECTION Date <br /> Approved as Construcled SignaWre of Applicant Date <br /> everett PUBLIC WGR�; DEPARTMENT WORK AUTHORIZED BV 7HIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 C�dar Sheet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF+ IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERI.�IT MAY Bc <br /> Phone: 259�88 i5 CANCLLLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />