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Date � /1 7 �� <br /> / ' ' "- ��„��,,_�ti�o�.��,,,m��, <br /> Applicalion For eiag ocoi • 9_t.,�?.�3 ]�� <br /> PUBLIC WORKS PERMIT P�o,,�Wa,�,��o ' <br /> .a�r�Fee s__ <br /> Less Aooi Fec P�i� $-� <br /> Print or Type Only Balance Due s___ <br /> �_ <br /> Kr�l)��-�- l��r,�cnal �b10 � � l . A }—��eiud,L �'i,?� oZS9 oZ�/,P � <br /> Owner MailingAdd�ess ��Y <br /> Z�p Phone <br /> .N/ <br /> Applicant Mailing qddress City_� <br /> Z�P Phone <br /> DeScribeProposedWork �PA/'n� IMA/niMA7PAf'� r Sol����P�,�t„uCH' �� <br /> J <br /> Project Atldress lif known� �D�0 � �t,�o� A,a ��p �,]n,�_._ � <br /> Atlach�our(4)copies of plans lor proposed work- Draw to scale and note the lollowin5 as applicable: � <br /> • Property Lines • Cenlerline ofsheel — <br /> • Outline and dimensions oi all existing antl • Intlicate Nnrth � <br /> proposed siructures on the let • Show an <br /> • Existing and proposed ulilities Y P�oPosed gra�fing changes <br /> • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shnll be made 24 hrs.in advance-phone 259-$$10. <br /> 2.All work shall be pedormed in accordance with this permit antl current Cily of Everett Design and Construction ' <br /> Standards and Speciiications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> � <br /> �� �� ���� � � <br /> -�„�`� F- <br /> � ��/� o <br /> a <br /> ACKNO WLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees lo hold and save harm� <br /> less ihe City ol Everet� from any and all claims :ar damages, costs. <br /> expenses, or causes of actioc Ihat may arise because ol installation <br /> and maintenance of Ihe improvement or o�he�righFof�way use hereto <br /> Approved for Construction Date applied tor anA further agrees to remove same upon notice hom the <br /> Cily and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant <br /> Dale <br /> everett PUBLIC WORKS DEPARTMENT WORh AUTHORI2ED BY THIS PERMIT MUST BE S7ARTED WITHIN <br /> � 3200Ce4arStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> Everett,WA gB201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259•8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUR.�TION. <br />