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-_ �_:__r <br /> Date �� � R O <br /> Puplic Worhn Permit• ✓ � �J/� <br /> AppliCation POr eiav Deo�.• <br /> PUBLIC WORKS �PERMIT PuOTotelFeeFee � <br /> , lesa Rool Fee Peia S <br /> Print or Type Only e.�,��a o�e s Z��–�'— <br /> �-��ft�En� ����Cal� 1��3 R�ck�R �l.°Ete�{� �c.)a S'&a�l �?S�i- y4.�4 <br /> Owner Mailing Address <br /> City Zip Phono <br /> SCirru��. <br /> Applicant Mailing Address Cit <br /> Y 2ip Phor,a <br /> Describe Proposed Work �:J �ULl�)Q�� ) '�r RC -��,��l �+� S1l �,�y�`c <br /> Projett Address(if known) (c� � ,'� �� C,� � � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note ihe�ollowing as applicabla: <br /> • Pr�perty Lines � <br /> • Uutline and dimensions of all ezistin and � Centerline ot sireet � <br /> 9 • Indicate North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Exi;ting and proposed utilities • Show measuremen;s <br /> DO NOT WRITE BEL6W THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspectinn sha�l be made:4 hrs. in advance-phone 259•88�5. <br /> 2. All work sha��he performed in accordance with this permit antl currenl City of Everett Design�nd Construction ' <br /> Standards nnd Specificalions. <br /> �3. Call Loca;ion Underground Service 48 hrs. bebre you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> !L C.�ALG FO.E �NSf�ECTic/t� �,c fo,L£ Z <br /> GOU2�.�/G Can�Ci"�TE, O <br /> � <br /> � <br /> � <br /> a <br /> .,d_ ACKNOWLEDGEMEN70F CONDITIONS <br /> -N.,., <br /> Thc undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett Irom any and all daims for damages, costs, <br /> ' expenses, or causes of acfio��. Ihat may arise hecause ol installation <br /> , g���� ��f%�6 and maintenance ol ihe improvement or other right-obway use hereto <br /> Approved lor Construction � ��e applied for and luriher agrees to remove same upon notice irom Ihe <br /> j/" City and to replace public property damaged ihereby. <br /> � <br /> � ��,:i �d-�"�� /� �" � . <br /> FINAL INSPECNON � � - • � � '�� <br /> Approved as Conslructetl ' a�e •'- -"� � � � � � ` ��� // � �� /` •�� <br /> Signature ol Apphcan� ' Date� <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZEG BY TNIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 I BE DILIC,ENTLY PURSUED TO COMPLET�GN.THIS PERMIT MAY BE <br /> Phone:259�8815 CANCELIED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />