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r <br /> _ , <br /> r <br /> � <br /> r Date� � ✓ Fu�licWmksPerml�r �� � _ <br /> App�ication For eiaq.oeo��+ � � <br /> PUBLIC WORKS PERMIT PueTotalFaa`°a : � °'�= <br /> Less AoO�Fae Peitl $ <br /> �d =" <br /> eaia���o o�e S --`': <br /> r Print or Type Only ' n <br /> / i <br /> Or' �r'� /" ]``�(� �i.t ��6 �i ���k���r 7G�i7.�^~ -�SS'-�l`i(� <br /> Owner Mailing Address City Zip Phone <br /> �//1 ( <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed WorF . ���}>�/ I�✓G�T �Il['��? ��/C <br /> W <br /> Prolect Addrnss(it known) � � ��r �' �� � <br /> Attach four(4)copies of plans for proposed work• Draw!o scale and note the following as applicable: � <br /> • Property Lines • Centedine of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structure:on the lot • Show any proposed grading r.hanges <br /> • Existing and pnposed utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 h�a in advance-phone 259•881 S. ^ <br /> 2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction ♦ <br /> Standards and Specilications <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER �•800-424•$555. � <br /> �/, Exi3+ i� �P���S u�� C n6C�s5 ���� �S v�c �" � b� O <br /> ��� � GJ o ..e� b«...� i.:, -�-o c�ee1� , <br /> S. CG,�e �s � �.."�z:.�er-. � Ke'r� w,15�T�"�i.ei-.o..-: � <br /> �z�J(-.4 � ..-� <�.:� \��.�t ;,..A-o uee k_ � <br /> l0• J O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> / less the City of F.verett from any and all claims for damages, cost.^,, <br /> expenses, or causes of action tY31 may arise because of installation <br /> �/ i and maintenance of ihe improvement or other right•of-way use hereto <br /> ���� �� `"'—� 3 � �� applied for and further agrees iv remove same upon noticn trom the <br /> Approved.�tion � Date CitY and to r a e Pub li PrcPertY dama9ed thereby. <br /> l <br /> s'�.z r�� 1 g � <br /> L FINAL�NSPECTION Date ' ��/ � � y� �-�� J <br /> Approved as Cons�ructed Siynature of Applic t Date <br /> everett PUBLIC WORKS DEPARTMENT WGRK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> O 3200 Cedar Sireet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPIETION.THIS PERMIT MAY BE <br /> Phone:259-BB75 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS Dl RATION. <br /> L `'� <br /> L <br /> J <br /> � <br />