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` 85 �/.3 <br /> D8t@ '� � � PUCI¢N'o�ks Permit• <br /> AppllcationFor emo.oso+.� y <br /> PUBLIC WORKS PERMIT Puo�icWonaiee , <br /> Tot�l Fee �33 C� <br /> leaa dDG�Fee P�iE s � <br /> B�lanca Due : 20 00 <br /> Print or Type Only <br /> o�« sd� /��/ <br /> �G,4s.��✓ �w/�� 3-si 3 rs`rh 1�R SC �i,�a.r� 9�aOS 33`�1�'�3 <br /> Owner Mailing Address City Zip Phone <br /> Si0/+9� � <br /> Applicenl Mailing Address City Zip Phone <br /> Describe Proposed Work ����`• e/ �T— C '����u � _" QRA�'�/ <br /> M H <br /> H '+1 <br /> W " � <br /> � <br /> Project Addresa(if known) H � <br /> Attech four(4)copies ol plans lor proposed work- Draw to scale and note the�ollowing as applicable: � � � <br /> • Property lines • Centerline ol street � � <br /> • Outline and dimensions of all existing and • Indicate North �„i <br /> proposed siructures on the lot • Show any proposed gradinp changes � y <br /> • Existing and proposed utilities • Show measuremenis M y <br /> W � <br /> DO NOT WFITE BELOW THIS LINE O N <br /> PERMITCONDITIONS �j � <br /> 1. All calls lor inspection shall be mede 24 hrs. in advance-phone 25J•BE15. � � <br /> 2. All work shell be pedormed in accordance with this pe�mil and current City of Everett Design antl Consiruction <br /> Stendards end Specilications. ~ <br /> 3. Call Locetion Underground Service 48 hr;.befo�e you dig.TOLL FREE NUMBER 1-800•424-555$. � � <br /> � � <br /> � ' � <br /> � � <br /> � � <br /> O y <br /> a � <br /> H <br /> � <br /> ACHNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicaM hereby agrees to hold and save harm- <br /> less ihe City ol Everetl Irom any anA all claims for damages, costs, <br /> expenses. or causes ol action thal may arise because of installation <br /> � �� b � g and maintenance ol the improvement or other righFol-way use hereto <br /> F applied tor and lurlh�r agrees to remove same upon notice Irom the <br /> Appwv�ed for Cons-t—r c�tion /. �e City and to replace public pmperly damaged thereby. <br /> ���� � � s'-�� ���-/ 1�/�Lrr�v,/ � /,;2] /�'S <br /> FINA�f�PECTION Date —� � <br /> � Date <br /> Approved as Constructed Si nature ol A lic nt <br /> WORK AUTHORI2ED BY TH�S PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PEAMIT MAY BE <br /> Everelt,WA 98201 CANCELLED 8Y?HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />