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i <br /> I <br /> Date�90 - � " ��� PWLCWorksPer'mti�•�f <br /> ApphcationFor eia� oepi.s�u�%-�7�9? _ <br /> PUBLIC WORKS PERMIT P�����W�,ksF�� <br /> Totai Fee $ <br /> Less AOp��Foe Pad $ _ <br /> Print or Type Only BalnnceDue s <br /> ��y.�'!M k P213x 7a8 ,k,�n„ 9�'7�� 3�� , �3�� <br /> vu�ner Mailing Address City Zip Phone <br /> ��n1e���22e�_P�Rx�g l���. � (�p,� 98�s_����— <br /> Apphcant Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �{�,� 9 ���'� ; <br /> s��r� ,Bv��o:.�e <br /> Proiec�Addresslifknownl �/lL-J ' �7�/ / � <br /> Attach tour(4) copies of plans lor proposed work- Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline of slreet � <br /> • Outli�e and dimensions of all existing and • Indicale North <br /> proposed structures on the lot • Show any proposed grading chanyes <br /> • Exisling and propo,ed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All wo�k shall be peAormed in accordance with this permit and current City ol Everetl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �lI7Ce /7�� C�"/''ire aJa r/ �i" ,Ue Car�.S��uc f�;� O <br /> �/ ��.6['ic, wor�s��rn��f ���1� /�e re��•i�e� � <br /> � <br /> �i�,����-- � <br /> /v 2 s• y'o a <br /> ACKNOWLEDGEMENT OF CONDITIONS , <br /> '` The undersigned owner/applicant hereby ac�rees to hold and save harm� <br /> less the City of Everett from any and all claims lor Camages. costs. <br /> expenses, or causes of action ihat may arise because of installalion <br /> and maintenance of the improvement or other righ��of-w•ay use hereto <br /> applied for and turther agrees to remove same upon nolice from the <br /> Approved tor Construction Date City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Sign2ture ol Applicanl Date <br /> everett PUBLICWORKSDEPARTMENT wORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet �8o DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 90201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8BI0 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PFOJECT OVER 90 DAYS DURATION. <br /> � <br /> I <br />