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3 5 'J` P�' k Workf Parmil t v� � 1 <br /> Date� <br /> Appllcation For eiav.oso�.• <br /> PUBUC WORKS PERMIT P°°'�°"'°'".`°° <br /> Tol�l Fae S <br /> Lest Appl Fee P�iE _ '/^ �.,/ <br /> Bal�ntn Due s L�5�.��/rF <br /> Print or Type Only "--' <br /> � , � <br /> � � � aP ,ez_Q�.�t�t° //���� I,t�r-� 7 q ,�i�„c,:�� �f.a�y .�3�- /3 r� <br /> pW�e MallingAddress City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> DeacribeProPosedWork �T4G�i= /Z�OOC� T�r/s-�c'��'��.FJS� <br /> oit/ Li�//�Evc�<o�-�'=.i� �C' C-:�tl- <br /> _ „�a�, q.'. _s,��e.�r � o W <br /> Pro}ect Address(il known) _ `��<<�«"' SH��'-� �n }il c /�9n71 - � <br /> Attach faur(4)copiee ot plans lor prcposed work• Draw to scale and note the follo•Hing,is applicable: � <br /> • Property Lines • Genterline of sireet � <br /> � Outline anA dimensions ol all exisling and • Indicate Norih <br /> proposed slructurPs on the lot • Show any proPosed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITICNFi <br /> t. All calls lor mspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be pnrformed in acCordance with ihis permil ar.d curreN City of Everett Design and Cuns�ructlon <br /> Standards and S?ecificali�ms. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE kI,IMBER 1•800•42$•5555. � <br /> O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant heieby agrees to hold and save harm- <br /> less the City ot Everett Irom any and all cleims for damages, coet4 <br /> �'�c��_' � �G,..'�=y�� %<l/tJ�f�� expenses, or causes of aCtion ihat may arise beCause ol instelletion <br /> ��� ��'� d� �/S/�` and maintenance ot ihe improvement or other righPul-way use hereto <br /> v�<c� X'o�"1"`-' � -' applied for and turlher agrees to remove same upon notice from the <br /> ; Approved tor Construction Date Ciry and to replace public property damaged lhereby. <br /> `y.,-� �i �� /( ,�,����£-Ca��GC <br /> FINAL IA�PECTION - Date <br /> Approved as Constr;,cted i7nature ol ApplicAM Date <br /> everett PUBLIC WORKS DEPAFTMENT WOFK AUTHORIZEO BY THIS PERMIT MUST dE STARTED WITHIN <br /> 180 OAVS OF DATE PERMIT IS ISSUE� AND THF.REAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLtTION. TH�S PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPJN ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> i <br />