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�8�e�� PuEIIc Worka Permlt s �./'l�y <br /> - ApplicetionFnr eiae�oep�.r � 3 <br /> PUBLIC WORKS PERMIT PubTo�elFeeFae s -- <br /> �a:s noo�Fea ve;e S <br /> Print or Type Only e.�a��a o��, s .�0.D� _ <br /> 'J7�38' <br /> �✓�.� �i eJ �qiz�i��s i f��L_._ o�/2r_LG �i,F�y� - `.�-��' <br /> Owner Mading Address City Lp Phone <br /> G�7X�C <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��,�,L�_,1,e,__ L ��'�-+ �J���� �����- <br /> .l <br /> W <br /> ProjectAddress�ifknown) -S2 ��—"' 2 �' ����� � <br /> Atlach four(4) r,opies of pians for proposed work- Draw tu scale and note tlie following as applicable: � <br /> • PrapeAy Lines � Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on ihe lot • Show 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•8�77 5. � <br /> 2. All work shall be peAormed in accordance with this permit and curre:rt City of Everett 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 /> O <br /> � <br /> � <br /> O <br /> a <br /> �p ACKNOWLEDGEMENT OF CONDITIONS <br /> i <br /> The w�dersigned owner/applicant hereby agrees to hold and save iiarm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> �. J e:aenses, or causes of action that may arise because of installation <br /> �� °. //�� /y' _� `c�'+� and maintenance of the improvement or other right-of-way use hereto <br /> '� �f' applied for and further agrees to re, ove same upon notice hom the <br /> Approved r Construcii�n . Date City an to replace public piopert d aged thereby. <br /> �� -//� /��/� j�/ �� �� � <br /> .E:���/ /6�� iJ._�f=�� 1�// {//� � l .i� S <br /> F�INSPECI'ION Date � �/ ; �i '� / �� � � � � �� � �' - �5-:5 <br /> Approved as Consiructed gnAtut e of"A�icnn �/ - ��i Date <br /> evere[t PUbLIC WORKS DEPAFiTMENT WORK AUTMORIZED B` THIS PERMIT'MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE pERM1T IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT M11AY BE <br /> Phone: 259•8815 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK OW THIS <br /> PFOJECT OVER 90 DAYS DURATION. <br />