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... . , ,... <br /> .. . . . . f74,di'TPT4"i:�2'R�"'eT-�.R-�.^"�^ . . . �..-_��gs�c'e"y�'�.T�"^w+�.�f':Sa1a1 1_.. 14"__ .:: i <br /> T <br /> Date // ��� Puoi�c Works Permn� � ���L <br /> Application For Bieq Deoi-• <br /> PUBLIC WORKS PERMIT °°°;o„<<:eF°° : — <br /> less Rnol Fee Paia S - <br /> . Balance�ua S ��� �yp�lF <br /> Print or Type Only <br /> �7 i. � ' , il \ J �.�" <br /> 1� 4e��s ;, i �_�.�� I� r.( �, 1_�� X Il�� �� �.�-e�L �7i'���C- �7' �- � -'; i��/ <br /> Ow er Maihng Address City Zip Phone <br /> �iYl+i-' <br /> qpphcant Mailing Adtlress City Lp Phone <br /> Describe ProPoseA Work..`_?�-\�� ": �- / C.i�`. � �,�. �` I � . I � � �- ; i'. <br /> � : � , �.�1-I<��S — �rrwi ..lu��� ! ''� -I��. n.i.���� ��f� �„�____�—��{-� �� � <br /> � i <br /> ��7 W � <br /> Project Address Iil known) �^'C: ��' �{ �.+_i(�-1, �� �! � r �� I�l�� ; i r � � <br /> Attach lour 141 copies ol plans for proposed work- Draw to scale and nole ihe lollowing as applicable: � <br /> • ProUerty Lines • Centerline of sireet � � <br /> • Outline and dimensions of all ezisti��g and • Indicate North <br /> proposetl siructures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Show measurements � � <br /> t <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � Do /✓01' 06�TtivGT //f�/�cLE /9fC_FSS �,�>OUG�i� �'LLl:1/ , O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS I <br /> The undersigned owner/applicant hereby agrees to hold ano save harm� � <br /> Q,e /�j_=/e .9�/�VGICNiS ,D/SC!/JS��� less ihe City ol Everett trom any and all claims for damages. costs, <br /> '. //TF:'� ��'vE dA���,ri•' � ezPenses. or ca�ses ol action ihat may arise because ol installation <br /> ��. /�,�,� and maintenance of the improvemenl or other rigM-oFway use hereto i <br /> � '��'A�'��"� applied br antl fur�her agrees �o remove same upon notice from Ihe <br /> Approved lor Constructicn Date Ciry and to replace public properry damaged ihereby. � <br /> 7/fC-�� <br /> ) � <br /> FINAL INSPECTION Dale '� - -�•�� ' � `�/t �"� � ' ' �-- F�� !� � 1 <br /> Approved as Constructed Signal�ie ol Applicant ' ' Date <br /> everetl PUBLICWORKSDEPARTMENT WORK�.AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 4 <br /> � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> 3200 Cedar Street f <br /> Everett,WA 98201 BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE � <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS } <br /> PROJECT OVER 90 DAYS DURATION. <br />