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Date /I /(/���z Publit Works Permil r � <br /> �. _.�Lle�Lf�L./(/—� BId9.0ePt.x � ���5~ � <br /> / <br /> Application For <br /> PUBLIC WORKS PERMIT PubTotxFeaFee $�,E,, � <br /> r <br /> Less AvO�Fee PaiC $ <br /> BalanceDuo $ �' � � <br /> Print or Type Only (�S`�9� <br /> _� Gc) ; // r S/o/-o2�ti0cJ ��eiec�" �s.� - �3i5� <br /> � Owncr Mailing Address City Zip Phone <br /> RM� <br /> Applicant Mailing Address Cdy Zip Phone <br /> Describe Proposed Work �d�1 SO�A/P i U h� �t' 'L�p�`�l°R — �����L- — <br /> �� 7 � <br /> � Project Address(if known) � ����'3�`'� w � <br /> � Attach four(4) copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> � • Property Lines � Centerline of street � <br /> • Outline and dimensions of�II existing and • Indicate Norih <br /> proposed structures on the lot � Show any proposed grading changes <br /> • Existing end proposed utilities • Show measurements � <br /> 1 <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEfiM1T rqNDITIONS <br /> - 1. All ca,ls for inspection shall be made 24 hra in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3. Cal�Location Undergrouncl Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � , <br /> yo 5�� 6� o(� wo�+��l Q� p�� i,..� �,w,�- b � O <br /> . � n 4 , 1 <br /> ..a� .���Y, `TNet.- a l0 Sa»�ta� S�we.r <br /> ea,ae�e...f�- �:. �-F�.v� .c.ret �,.. � P,p� I,.;e.� �r,..- .I.p.z � <br /> �wo ac�J�.ee.•.A' ��+"+ e�e �� eae�, N <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIO�'S <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less the l:ity of Everett from any and all claims for damages, costs, <br /> expenses or causes of action that may arise because of installation <br /> ��/Q,�� � and maintenance of the improvement or olher right•of•way use hereto <br /> applied f�r and further agrees to remove same upon notice trom the <br /> � pproved for Consfruction Date City antl to replace public property damaged lhereby. <br /> �� �� % �- +" S �� � //�7� ��y�,/ S p <br /> N.4L INSPECTION Date C_�-':V�y"� d' • �1 �!J -o�'°!�-J � <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMF'LETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. <br /> �__ <br />