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. .�r;�,`p`' �'�'' az'�;. <br /> �J. ..�.++�.. _ �' �.« �,;a# <br /> Date���'p�-�l' Pobfc wO,Ms ae,mi�, �' Cc'�"�� � <br /> Application For aiao.oea�.. l� <br /> PUBLIC WORK� PERlVliT Pu0licWorkSFee <br /> Total Fee � <br /> less AppL Fee Paltl S <br /> Print or Type Only BalanceDuo S li�S.� /7 <br /> �G ,�. �iv e // 9DU '��, �'� ��P,�e� �P ��� �S z-3 i �,� <br /> Owner � MailingAddress City Zip Phone <br /> L(J �J/, f�d tvP ,�GO �`�e, �;U �i Prr.�9,F� i .��"S .3�� <br /> Appli ant MailingAddress City Zip p��o�e '� <br /> Describe Proposed Work � �.��r ��f /'���� �/��� <br /> � <br /> � � v � � <br /> Prolect Address(if known) � � - � � <br /> Atlach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> ' • Property Lines • Centerline of street 'w <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> ! Existing and p�oposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance� phone 259•881 5. �„ <br /> 2. All work shall be performed in accordance wilh this permit and curreN City of Everett Design and Construction �j <br /> Standards and Specifications. <br /> 3. Call Location Underground 3ervice 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> ^t /'0'� / �/Gin—C� ,{�<C�� 2` Z �7 ��S�i /�\ <br /> 5 ' �.� <br /> � �'�'L/cfJ�/7' TO ��D///OE �E�?FO.ein�,�/G� <br /> .d'oiv� i.r� Tr�E 9.�ori.�/T oF �`Z lo6�v `L.° � <br /> Y♦ <br /> � <br /> � <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold arid save harm- <br /> —� less ihe City of Ev�rett from any and all claims for tlamages, costs, <br /> ,����� expenses, or cau�es of action that may arise because of installation <br /> // �< and maintena�ce of the improvemenl or other right-ohway use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> �v. for CDfistrucy' n Date p;ry and to replace public property damaged thereby. <br /> ��.��/�� ci-'�Y-�G <br /> b+�NSPECTION Date <br /> Approved as Constructtrd Sgnature of cant Date <br /> everett PUBLIC N'ORKS DEPARTMENT WORK AU H IZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreet 180 DAYS DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-9815 CANCELLFD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />