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L_ . ._ _ - <br /> Date�G `"%` �` <br /> PueLc won�Peprm/�l�s <br /> AppIIGBtiOn FOr eioa.oeoi.���L' �7�7� <br /> PUBL,IC WORKS PEP,MIT PuplitWorktFee <br /> Totel Fee s <br /> LeN Rppl�ee PaiO S <br /> Print or Type Only Be�a��e o�e t <br /> Roba.-� Lt)o,�, �)1 /,ns, /p�[� .�i�PiA�7' /�'r� �G�I �Ss 9/ S <br /> Owner Mailmg Address Cdy 2ip Phone <br /> E✓��Ptl gu�IcQ�U S(�CG F_ vpia.r �� ��G.� �i� �S,?//6 <br /> App6cant Mailing Atldres City Lp Phon� <br /> Describe Proposetl Work . H���,y/1 �) �(Jryl � <br /> i <br /> Proiect Address(if known) l 7� `"�i ) �[�p/ L� � <br /> Attach four(4)copies of plans br proposed work- Oraw to�cale and nole the lollowin g as a p plicabl e: � <br /> • Property Lines • Centerline ol streat � <br /> • Outline and dimensions of all existing and • Indicale Nor�h <br /> proposed structures on the lot ! Show any proposed grading changes <br /> • Ezisting and proposad utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•8615. � <br /> 2. All work shall be pertormed in accordance with ihis permit and current City of Everett Desipn and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER �•800•424•5555. � <br /> ��(�/f✓�=/G LUo,2;E'_S� /�c`�,�ini-' �Lloi ,<��291/i,C'�'.�! O <br /> .-�;�%f;�' �-- <br /> � � <br /> � , <br /> , � �5,� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of Everetl trom any antl all claims for damages, costs. <br /> expenses, or causes oi action that may arise because of installation <br /> and maintenance of the improvement or o�her righl�of�way use hereto <br /> Approved for Conslrudion applied for and further agrees to remove same upon notice Irom ihe <br /> Dale City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature oi Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT �'�'ORK AUTHORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8815 CANCE�LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />