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1 S Vubl�c Workt Permh• ���/ <br /> Date �' ��D� — <br /> 91ap.Deo+.• <br /> Applicetion For _ <br /> PUBLIC WORKS PERMIT P°°°`"'°�.`" - <br /> Tol�l Fee � <br /> ' Le�s�JClfeePeiO �—�— <br /> B�I�nce Due s /���� _ <br /> PNnt or Type Only /�i1�0 �fF� ��'Z7y2 <br /> T' 'AI C�. �..D `�l�t G �IC�O Gvta-EC� 't`�p—�.'�-l•-b1� <br /> JOItJ 1"'l�K–f "`F�" CRv Zip Phone <br /> Owner Meil�ng Address <br /> �`�E�., C_v.�s.e �1 � �o+ 99'l o �.x-ktr�E �tzb l W �8o e�'1� U <br /> ApO�icanl ^ <br /> Mailing Address �'�1' <br /> .,.05 �+� en+ ��' S�t7Swf4�K /�T �h..+N'/ �Lv�. <br /> Deseribe Proposed Work /� =R r�-- <br /> W <br /> � z� s� ���. � <br /> Pro�ect Address(if known} — <br /> Attech four(4)copies or plans for proposed work-Draw 10 scale and note Ihe following as applicable: � <br /> • Property Linea • Centerline of street <br /> • Indicate North <br /> � putline and dimansions oi all existing and � Show any proposed grading changes <br /> proposed structurea on lhe lot � Show measurements M <br /> • Existing and proposed utilities W <br /> DO NOT WFITE BELOW THIS LINE O <br /> PEAMIT CONDITIONS � <br /> 7. All Calls f�r inspeCtion Sha�l be mad=2d hrs.in advance•Phone ZBJ•BB�S. <br /> 2. All work shell be paAormed in ea�ordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specificetions. � <br /> 3. Cail Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•S00'424•$SSS. <br /> f! T BE COyST,2�/�'TEo PE.0 .q P�'.C'OVEt� PC dNS O <br /> S/G.✓fO .�P�D D��ED /4-S-8f� <br /> � <br /> � <br /> O <br /> a <br /> ltCKNOWIEDGEMENT OF CONDITIOhS <br /> The untlersign=d owner/apn��cant hereby agrees to hold and save harm- <br /> less the Gily of Evere�� irom aoy and all claims for damages, costs, <br /> eapenses, or causes ol action t'+ot may arise beceuse of instelletion <br /> i� � and m.;intenance ot the improvern+nt or other righFol-way use hereto <br /> /��/�}'_�� �� � applied for and lurther agrees to iemove same apon notice from the <br /> Approved for Conslructio a�e City and to replace public property�aged thereby. <br /> - �;� � r-- � ) ,-��-a� <br /> FINAL INSPECTION Date � � Date <br /> p�proved as Ce�siructetl <br /> Signature of p'�plicant <br /> WORK AVTHORIZED BY THIS PERMIT MUST E STA?TED WITHI <br /> evere[t PUBLIC WORKS DEPARTMENT 180 DA1'S OF DAlE PERMIT IS ISSUED AP'7 HEREAFTEF IS TO <br /> � 3200 Cedar Street �E DILIGENTLY PURSUED TO COMPLETIO�. THIS PERMIT MAY BE <br /> Everefl.WA 98201 GANCELLED BV THE GTY UPON ANY STOPPAGF OF WORK ON THIS <br /> Phon�: 259-8�15 PROJECT OVER 90 DAYS DURATION. <br /> t <br />