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i�o <br /> � �"� <br /> �. <br /> � <br /> r-� I' � Q �a 355- / I <br /> Date.�L_LLL� 1� P�r�::,�o,ks P�,m� , <br /> � <br /> Application For eiay.oeo�..— <br /> PUBLIC WORKS PERMIT PULTotalFee`°° � <br /> L��ss nooi.Fee aa�n S _ � � <br /> Print or Type Only BalanceDue 5 2-O I <br /> ; <br /> � <br /> .���.f�� c. ��'��`� ��33 �'!-"A1t_� �t �� �1 �1'�'.#� 9��-�3 ��s�'��-/�' � <br /> Ov,lner Mailing Address City Z�n Phone :i <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ������ �nTl��' 1�-��l — <br /> p � � Arir1 �'f k n vnl •-�� / /� �� � <br /> Atlach four(4) copies of plans for proposed work- Draw to scale end nofe thc following as applicable: � <br /> • Property Lines • Centerline ot street ,/� i.j <br /> • Oulline and dimensions of all existing and i Indicate North �V� <br /> proposed siructures on the lot • Shmv any proposed grading changes <br /> • Existing and proposed utilities • Sl��ow measurements � , <br /> DO NOT WRITE BELOW THIS LINE � <br /> PEFiM1T CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.ir,advaoce-phone 259•8810. � ' <br /> 2.All work shall be pedormed in accordance with this permil and current City of Everelt Desic�n and Construction <br /> Standards and SFecifications. � <br /> �.Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 1-800•424-5555. � I <br /> �S. -PIZ..�y����.� At"�2oN �lA�.l__. NOT �XG,EE.I� � I <br /> Z� � I *1 �.�/ t DT{-F , i <br /> � <br /> �/ � <br /> � <br /> � <br /> �( � ACf<NGWLEDGFMENT OF COtlDITIONS I <br /> ��E- The undersigned owner/applicant hereby agrees to hold antl save harm� i <br /> less the City of Everett Irom any and all claims �or damac�es. cosis, <br /> expenses. or causes of aclion that may arise because of ins�allation ' <br /> ��.�� nnA � �� -.7 ^z .r.J _c�I and maintenance of ihe improvement or other righDol-way use hereto <br /> � �� applied tor and luriher agrees to remove same apon notice Irom ihe <br /> ApUroved for Cons r Ftion Date � City and to replace public property damaged ihereby. I <br /> "��— /.1- r-9v � -f� Uu�- � �—�� <br /> FINAL .� _CTION Date <br /> Approved as Cunstructed Sig alure of Ap icant Date <br /> WORK AUThiORIZED BY THIS FERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT i80 DAYS OF DATE PEIiM1T li ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO CCMPLETION. THIS PERMIT MAY BC- ' <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />