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� ' � `/ f� <br /> Datr !/' G'�/ (J� P�Olit Wo�ka Pa 11• �T � 2�`�' <br /> r ` � • BIEO DePt• ��/� •� ` 'b � <br /> ! �Applicatio or <br /> PUBLIC WORKS PERMIT P��I�cWorknfee <br /> Totei Fea S <br /> Less hppl Fee Pe10 S <br /> Pfint Of TypB Only e.�.��ao�, S LO.00 <br /> � '�"' �� <br /> � � � �� r- <br /> i'���� ���,�, v' 'S / : `:� % f� uclsr.� � .i �— �,i,s� - i�%� �� <br /> Owner Mailing Address City Zip Phone <br /> �_l A n� ,- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposetl Work �--�- `� " �� � "�-� i��.. <br /> ` <br /> , W <br /> Prc�ect Address(i(known) �-; C1 ) 1\-' , !., r='R:� � <br /> Attach four(4)copies of plans lor proposed work•Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> • Outline end dimensions of ell existing and • Indicate NoAh <br /> proposed structures on the lot • Show any proposed grading chenges <br /> • Eaisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs in advance-phone 258•8815. � <br /> 2. All work shell be performed in accordance with this ermit end current City of Everett Design and Construction <br /> Stendards and Specificationa <br /> 3. Call Location Underground Service 48 hrs. before ou g.10LL FREE NUMBER 1-800•424•55bb. � <br /> � <br /> v O <br /> _ � <br /> � <br /> � O <br /> a <br /> �% ACKNOWLEDGEMENT OF CONDITIONS <br /> ` ,F <br /> The undersigned owner/applicant hereby�grees to hold end save herm- <br /> less the City of Everett from any and all claims tor demages, costs, <br /> � expenses, or causes ot action that may arise because of installatlon <br /> � 7 -� ' J/ and maintenance of the improvemenl or other right-of-wey use hereto <br /> � f .4. „ _, � �('��� i <br /> ,r �1/i�� N-%J.- � /-=�'"' - %f' i �. f' applied lor and further agrees to remove same upon notice from the <br /> Appro ed for Construction � Date City and to replace public property demaged thereby. <br /> FINAL INSPECTION Date �'-�"� n '���n-`'� — %'�i 'J�'ti� <br /> Approved es Constructed Signature of Applicant Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STA(iTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98�01 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />