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«. <br /> -- --- <br /> � i <br /> Date � 3o Public Works Permll s`+ <br /> Bltlp.Dept�_ <br /> Application For <br /> PUBLIC WORKS PERMIT PUEIIcWorkaFee <br /> Tolal Fea S � � O <br /> Lass A00�Fee Psid s - <br /> Balance Dua S ' � <br /> : Print or Type Only � G yL`J <br /> ! <br /> �o.,oPo,� _ o-� 4yiy-z3 �` u/ <br /> Owner iling A dress City Zip Phor�e <br /> Applicent Mailing Address City Zip Phone <br /> Dascribe Pro sed Work � � Ct a+t �- •u i d'� � CK <br /> Vo+� 4rca – w�ax� m...., o� y [7 3 <br /> —T i <br /> W <br /> Froject Address(if known) `a��3 ����~ 's���r" ^"'""S �V •#� � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � � � <br /> • P:operty Lines • Genterline of streel � � <br /> • Outl!ne and dimenslons of all existing and • Indicate North <br /> prop��sod structures on the lot • Show any proposed grading changes <br /> • ExisPng and proposed utilities • Show measurerr�ents M <br /> W <br /> �� DO NOT WRITE BELOW THIS LINE , <br /> � PERMIT CONDITIONS O I <br /> 1. All calls for inspection ahali be made 24 hra in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in eccordance with this permit and current City ot Everetl Design and Construction <br /> Standards and Specificationa <br /> 3. Call Location Underground Sarvice 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424•555�5, � <br /> � Esoa�e.� so-�-�r� � � `se n.a ��sllr,� �e S.t.-�.:�ac�m:. O I <br /> .� Pkw�� �,.o.l�� �.���� I <br /> S: �rw.Y:.aSe� ��-- Proe� R�.o..t ls t+er�- �.. �et �oloc{ceJ/ �'a � <br /> �O. �r� �OGrw�� �s! ��w'a ��0 ►tc O�P.r � <br /> � ( d /� O <br /> -1L- t I� � �+ �p <br /> �UNt �f'�IL� qKA�� W 1 � � rt�41R`C Q S.GJr K, � I <br /> I <br /> reu;�.,.� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- � <br /> �ess lne City of Everett irom any and a�l cleims for damapes, costs, � I <br /> expenses, or causes ot action that may arise beceuse of instellatlon <br /> �/3� and maintenance ot the improvement or other right-of•way use hereto <br /> applied for and fuAher agrees to remove same upon notice from the <br /> tor Conatructio /� City ant to replace public property dameged thereby. <br /> .�%.sf� __s!"L�`�I <br /> ,_�-�r � ./��_ � <br /> �� Fli�i LII ION Date 'M � � � Date <br /> Approved as Constructed Signature of Applicant <br /> LYORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere1 PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREP.FTER IS TO <br /> � �200 Cedar Streat BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everei;,!NA 98201 CANCELLED BY THE CITY UPON ANY STOPPACaE OF WORK ON THIS <br /> Phone:259•8875 pROJECT OVER 90 DAYS DURATION. <br /> . J <br />