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� y P�„�,�„�,,,Pe, ,. 8u- ���a <br /> Dafe_��� e�ao o,.o, .� ' 3 .�Jr <br /> Application For <br /> pUBLIC �'NORKS PERMIT Puei�cworheFee <br /> Tolal Fee S <br /> Less AoO��Fae Peid S <br /> Belence�ve � ���� <br /> Print or Type Only 6,��o yP <br /> � [ I P:1/: �.3 �� �Vcl1� - �J7`— ,d�sPhone iCC�,Z .� <br /> Owner Mailing Address City Zip <br /> �] �H�r City Zip Phone <br /> Applicant Meiling Address <br /> / i t, / <br /> Describe Proposed Work � 7 X°� 7 � �9 �� <br /> -- W <br /> Projecl Add�ess(il known) /� �� <-"' � � —`�-=— � <br /> �� <br /> Attach lour(4)copies ot plans for p.cposed werk- Draw to scale and ��ote the following as applicable: � <br /> • property Lines • CenteNine of sireel <br /> • Outline and dimensions ol all existing and � Indicate Norih <br /> proposed structures on ihe lot • Show any proposed gradino changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEHMIT(;ONDITIONS � <br /> 1, All calis tor inspedion shall be made 24 hrs. �n advance- Plmne 259•88�5. <br /> 2. All work shall 6e performed in accordance with Ihis permit and current City ot Everrtt Design and Consirudion Z <br /> Standards and Specifications. � Q <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBEH 1-800�424•5555. F�-, <br /> � <br /> O <br /> � H f <br /> N y r� <br /> H � <br /> O � �. <br /> a � � <br /> � � <br /> � <br /> � �. <br /> � , ACKNOWLEDGEMENT OF CONDITIONS � .`- <br /> � � iF. <br /> The undersigned owneriapplicant hereby agrees to hoid and save harm� y p. <br /> less ihe City of Everetl Irom any and all claims for damages, cosis. <br /> K <br /> expenses, or causes ol action lhai may arise because ol installalion O t- <br /> �/ iJ�� p����� and maintenance of the improvemert or olher righl-o��way use hereto � �. <br /> �/,,� � i :pplied for and Wriher agrees to remove same upon nolice from Ihe <br /> q p pr ved for Construqion ' / �a�e City and to replace public property damaged lhereby. �,, <br /> ��' /��"`� 3 1"0-E(r � [ <br /> � n �C� a� �-�)-.f7Y � <br /> FINAL INSPECTION Date Date <br /> qppro,;;d as Constructed Signatwe ol Applicant <br /> WORK AUTHORIZED BY THIS PER611T MUST AF STAFiTED WITHIN '-� �.� <br /> evcr�« PUBLIC WORKS DEPARTMENT 180 DnYS OF DATE PERMIT IS ISSUED AND THEREIFTEN IS TO �. <br /> 3.^JO Cedar Sireet I BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Fvvreli,WA 98201 CANCELLED BV THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> e� ph;�¢ 253-8815 PROJE:.T OVER 90 D�YS OURATION. <br />