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Po�lic WorMs Permp� <br /> � 7–��0 � <br /> Dat@ ZI `6� eiae oao�.• <br /> qpplication For � <br /> PUBLIC WORKS PERMIT PuEfmWorknFee <br /> Total Fee s <br /> Lean AOG�Fee PeiC S <br /> Belance Due S <br /> Print or Type Only <br /> �.v� cr� ��s� t�4 �` IayS �u �8�3�� 7 <br /> Owner Mailing Address <br /> CitY Zip Phone <br /> G �� ti <br /> � ( < < � <br /> � � CitY Zip Phone <br /> Applicant Mailin0 Address <br /> I .� :�t� s �� «�-� Gti_ ��.�,�-�2� <br /> Describe Proposed Work �`' �7 ^ � L/ <br /> 1 .L.-, r�ct�e es�C .3P� /Odl"u rsT /Z � � �t+�p�� <br /> FI _�. t.�ORK�Z �OS <br /> � �� �s a � L.� �� n.to � • � <br /> ; f�z� -w�;�o,�s- +-N � <br /> Frolad Address(if known) – — <br /> Attech four(4)copies ol plens lor proposed work- Draw to scale and nole the fotlowing as aOPlicab�e: � <br /> • Property Lines . • Centerline ot slreet <br /> • Outline and dlmensions of ell existing end A Indicate North <br /> proposed structures on the lot • Show any Proposed grading changes � <br /> • Ezistinp and proposed utilities • Show measurements <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1, All calls for insper,tion sha�l be made 24 hrs.in advance- phone 259•8815. <br /> 2. All work shell be perbrmed in eccordence with this permit and current Ciry uf Everell Design and Conslruction <br /> Stendards and Speciticetions. � <br /> 3. Call Location Underground Ser�ice 48 hrs.betore you dig.TOLL FREE hUMdER 7•800•424•5555. <br /> .�—�� \`� O <br /> )* ���' �" Y I'�' <br /> cG��^ b� R�« � � <br /> l� na.• � ,� � <br /> �,� �� , � O <br /> �¢'�c+.tK�� 'ik `l•,s�t�.� �t��a�J �1�rr�.cw•�' � <br /> ,y o.. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City of Everett from any end all claims for damages, cosis, <br /> �' � expenses, or causes of action lhat may arise becaus=, of inslalletion <br /> `� 1 �. � r� � and maintenance of the improvemenl or other righPohway use hereto <br /> �_l______ �,i Z/ /S( � appli nd lurther agrees to remove same upon notice irom the <br /> �roved for Cohslruction D2te y and to t lace public roperty damaged thereby. <br /> � `���� � �� <br /> FINAL SPECTION a�e <br /> Sig � ru ot Applic <br /> Approved as Constructed y�r K AUTHORIZ BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORY.S DEPARTMEN7 � 0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet 8E D�LIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evere�l,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON 7HIS <br /> Ni�ene:259-1�$�Od PROJECT OVEF 90 DAYS DURATION. <br />