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� I� <br /> � � <br /> �ate-- P�o��wo,k.P�,m��a 'l 'i , I <br /> ApplicationFor emo-oeo�.= _ i <br /> PUBLIC WORKS PERMIT � ;, <br /> PuOIICWorks�ee !/ �/ <br /> �iotai Fce 5����� <br /> �ess appi.Fee Paia $� �'' <br /> o,i,�«o�� S li' ��� ' <br /> Pi int or Type Only I <br /> � L <br /> � ' / / �' - ' �-l�' ���/`� �? � ,�7� I <br /> � � /'`�,� r� i. S O l�lLi,/��P�c ,�,� S- �(�i r� , <br /> 'Owner Mai4ing Address Ciry Zip Phone , <br /> ��2,��'L ��'��/ ,�����y ���� �,.�, , �"3��03 3.S'3 2_ F�F��� <br /> Applicant MaJing Address City Zip Phone �. <br /> � /.'u r�� �- ,�1,0/. <br /> DESCribe PropoSed Work _ � <br /> — a ` + W <br /> Proiect Addr=ss(if knownl �� - � � <br /> Attach lour(4) copies of plans for proposed work- Draw to scale and note the following as applicable: o <br /> • Property Lines • Centerline ol sireet ♦� <br /> • Outline and dimensions of all exisliny and • Indicate North d� <br /> proposed structures on the lot • Show any proposed grading changes <br /> e Ezisting and proposed utilities • Show measurements Y <br /> `er <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All�alls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in acwrdance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �� � / � /-/ 9 -�U � <br /> �� O_�-�c-r �;� ,� 1��,° �'�r°�' � ��-c� <br /> , <br /> ,' ` <br /> � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undeisigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from any and all claims for damages, costs, <br /> ._-��/7� ezpenses, or causes of action that may arise because ot installation <br /> / ��� and maiNenance of Ihe improvement or othar righbof�way use here�o <br /> � //��J� applied Wr and fwther a9rees lo remove same upon nolice from ihe <br /> Ap q ed for C9 stru ' �3�e City and to re lace public prOperty damaged theieby. <br /> ( / <br /> � �°yt� /a-I'-�s <br /> FINAL INSPECTION Date � �� //�l'�� � 1 5 j �� <br /> Approved as ConSVucted Sig�a�ure ol Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W!THIN <br /> everett PUBLICWOFKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStree[ BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM1IIT MAY BG <br /> Everelt,WA 98201 CANCELLED BY TFIE CITY UPON ANY STOPPAGE OF WGRK ON THIS <br /> Phone:259-8870 PROJECT OVER 90 DAYS DURATION. <br />