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/ <br /> Date I PuOLC Worka Permit� __�� <br /> Application For e��� �`"; , <br /> PUBUC WORKS PtRMIT PubToteFeeFeB S � .n — <br /> Lesa App'.Fee Pn�a S_�_ <br /> Belanca Due S ZQ <br /> Print or Type Only <br /> �.J � ��i .. .�n ��c,k-�.Y_��,,(� m"t�-v�ve,�{- �Ik�ol .�.i�_e3/1� <br /> Owner Mailing Addiess City Zip Phor�e <br /> A-I�v� <br /> Applicant Mailing Address Ciry Zip Phor.e <br /> �escribe ProPosed�nrk �C�I- 1 � (�`��� �'�m SD 1 I S �Yt�1�l P C �'e+. •-�� 1 A I�.�1 . . <br /> �/ f_ K— Lf n���1L�sd'.%�� - - . . <br /> Proiect Address(if known) �E�-{^ �G� ��r� �e � <br /> � <br /> . Attach lour(4)copies of pians for proposed work- Diaw to scale and note ihe following as applicable: � <br /> • Property Lines • CeNerline of sireet � <br /> • Outline and dimensions ot all existin�7 and • Indicate North <br /> proposed='�uctures on the lot • Show any proposed grading charges <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> • � PERMITCONDITIONS <br /> � � � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> , 2.All work shell be peAormed in accordance with this permit and current City of Everett Design ard Construction <br /> . Standerds and Specifications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �• Eros, er� �'�y! o�►�o � �'�„r C��� .lns/2�`�►— rt�/�,.��-�s O <br /> s ��,:� .�,�r,r�s 5��. 3�, � 9 � Z I— <br /> �n. ( v� �1�a�'/it j - /�� (�Ya c�rt ry V♦ <br /> � '� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�signed owner/applicanl hereby agrees to hold and save harm- <br /> less the Ci�y ot Everett Irom any and all claims br damages, costs, <br /> ezpenses. or causes of action that may arise because oi installation <br /> and maintenance ot the improvemenl or other righ4of-way use hereto <br /> applieA lor and further agrees to remove same upon notice irom the <br /> Appr d for Co rucf aie ity and to replace pu6lic property damaged thereby. <br /> ��� �- L -f i �.�t.�c�.`i <br /> fINAL INSPECTION Date <br /> Approved as Consiructed Sic�natwe ot Applicant Dale <br /> /Ar� PUBLICWORKSDEPARTMENT WORK AUTHORIZE� BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />