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�a�c,y-+-�—�—{— U �y- __ Pu�M1c Worxf Permit• t7(O � ���/ <br /> �_ <br /> Application For eioe oeoi . <br /> PUBLIC WORKS PERMIT �ublicWarksFee — <br /> Totel fee s <br /> Lese Rppl Pec PaiO s�— <br /> Print or Type Only Balance Due s �aD � <br /> �S�e�e ���sh�� /9r�/ /(uc�CPr r 9�ao� a.?5a-0�3y� <br /> Owner Mailing Address City Zip Phone <br /> 5��� <br /> Applicani Mailing Address City Zip Phone <br /> Describe ProPosed Work �!/�. .�� ."' �:� .'' ��^ _ �. ., .. � �r�'�. 1'n .� � f� <br /> }---sy�� <br /> ti i <br /> a � ' / / <br /> �-,o � W <br /> Prolecl Address lil known) " V � <br /> AOach four(4) copies of plans for proposed work- Draw to scale and note the following as applica6le: � <br /> • Propeny Lines • Cenledine oi street �A <br /> • Outline and dimensions ol all existing and • Indicale Norlh V� <br /> proposed struclures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposeA utilities • Show measurements � <br /> DO NOT WRITE BELOW TNIS LINE <br /> PFRMIT CONDITIONS O <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259-881$. � <br /> 2. All work shall be perbrmed in accordance with this permit and current City ol Everett Design and Construction <br /> Slantlards and Specifications. <br /> 3. Call Localion Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER 7•800-424•5555. � <br /> }/ L��[:�:.._ i�' dC t7n�✓f� J'liP A:-.'._��4iEV O <br /> %�GOT �-�L r?N.. <br /> � <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Gty ol Evarett Irom any and all claims for damages. costs, <br /> ���— ' expenses, or causes ot aclion that may arise because of installation <br /> / //�,�J�." and maintenance ol the improvemeN or olher rigM-obway use hereto <br /> ��� �SZ"` �� applie fDr nd further es re oyye same upon notice trom the <br /> Apf�r v`0 ed(6r ConSfrudjorf / � � Date Cii an � fe I Cp p hC o rt <br /> � y /9 a y. p �ged ihereUY. ' . <br /> �r���4��-- �6 _/l -�f-` (�r�/ � �-,��� <br /> FINAL INSPECTION Date / � � �� — J(L <br /> ApProved ss Constructed Signature ol ApPIiwM Date <br /> everet� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY TNIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAVS OF DATE PERNIT IS ISSUED AND THEPEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMP�ETION.THIS PERMIT MAY BE <br /> Phone: 259-BB15 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />