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�, <br /> , _ " � <br /> Date g 3� Publlc Worka Permlt R � �� <br /> Applicetion For aiae�oap�s <br /> PUBLIC WORKS PERMIT PUEIICWarkeFee <br /> TD�a��ae : •� � <br /> �� <br /> Leas AOG�Fae Paid s <br /> Ba!ence Uue S �� <br /> : Print or Type Only ���� ✓ <br /> 7 <br /> Owner Meiling Address City Zip Phone <br /> $�� 0;8rt��/ .S.►�s �sf ,Sb37 33�.�* � E�....�11` 9dru� .�53 4Zs� <br /> Applicent Mailing Address City Zip Phone <br /> Describe Proposed Work I 6� e �e <br /> ��/sfl T�1 <br /> ProjectAddress(if known) � ^�y �+a'�"''r'^' ��^"` 1 �v # � <br /> � <br /> Attach four(4) copies of p�ans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dlmensione of all existing and � Indicate North <br /> proposed struc�ures on the lot • Shuw any proposed grading changes <br /> • Existing and proposed utilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current Cily of Everett Design and Construction <br /> Standards and Speciflcationx <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> /• EY6.�IOA COM�) � ��i � M.S�4 �I<<Y � 5��0✓1 O <br /> � Pwbi« we�k� �.�ec�, <br /> S. '�'....».�� �+�— (�"�e�t,.s �abm..e ►a � �-�'m �a � <br /> b loe.{«� � <br /> 4. A�.� -�,�.. P..rw..l� �/� -��1� :.� ,.. �1.,3 �c.� 0/� <br /> a�� `�-�l,ts a.�,�+o.o..e.Y Sw•r.i:1•� �,,,.11 re�`�,.�rG. i�i <br /> 1 5. E-.�.�} ) <br /> • rCN�t'..e� <br /> ACKNpWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and seve harm- <br /> less the City of Everett from any and all claims tor demages, costs, <br /> expenses, or causes of action that may arise because of instellation <br /> � and maintenance of the improvement or other righhot•way use hereto <br /> applied for and furiher agrees to remove seme upon notice from the <br /> �fipproved or Constr cY n and to replace public pr perty damaged thereby. <br /> � ` 7� r�� �� I�(/ � <br /> . i <br /> � FINAL INSPECT ON Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> � _.1 <br />